Tag: #medicalbilling

Posted in In The Know Series, Insurance, Training

UHC Commercial and Oxford updated policy for Eucrisa® (crisaborole)

Posted on by KR2Medical Billing

Eucrisa® (crisaborole) coverage has gone through changes in the past 2 years.

In this episode we will cover only the coverage for UHC Commercial + Oxford policies

Things to take in consideration:

  1. Eucrisa® (crisaborole) is part of Pharmacy Benefit for UHC Commercial + Oxford policies.
  2.  It is a Step Therapy
  3. Policy was created in 07/2017 and Updated with no changes on 07/2018
  4. Effective Date is 10/01/2018
  5. Authorization is given for 12 months
  6. If the patient had samples of Eucrisa prior to the provider initiating Prior approval, that patient still needs to meet the Step Therapy requirement

Please look below for reference:

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Posted in In The Know Series, Insurance, My services, Training

OptumRx and prior authorization fax numbers-updated 2019

Posted on by KR2Medical Billing

As of 11/01/2019 OptumRx will be “retiring” the following fax numbers, for the plans that it manages the pharmacy benefits:

800-527-0531

855-806-3524

855-806-3525

855-806-3526

800-203-1664

800-382-8135

From 11/01/2019 on wards providers would need to visit an online website to complete the prior authorization:

https://professionals.optumrx.com and click on the Prior Authorization link.

Due to individual state guide lines, the providers in the following states are to still use the fax to request the Prior Authorization:

Massachusetts

Rhode Island

South Carolina

Texas

The new fax number,  for the providers located in the above states,  will be available via online starting in October of 2019

 

Posted in In The Know Series, Insurance, My services, Payers and CPT reinbursement, Training

Aetna and Vitamin D assay testing- 2019

Posted on by KR2Medical Billing

Last week I had a conversation with one of employees that works in the OBGYN office.

She said: ” Kate, I have a very large pile of denials on my desk. They all have to do with Vitamin D testing/screening for my Aetna patients. In the previous years, our office had no problem with testing women for Vitamin D. Now I have no idea what is going on? Is there anyway you can help me out?”

I said: “Sure, let me look in to it and I will let you know by tomorrow.”

Later that day I find out the following:

According to Aetna the Vitamin D assay testing is considered to be experimental and investigational for routine preventative screenings. 

The next day I tell that employee what I found out.

She says: ” Wow. None of the people in my billing department had any answer for me! Thank you very much. I will pass this information on to both my clinical staff and my billing department. You are a big help!”