Posted in HealthFirst, NY Providers, Payer Updates, Training, Updates

HealthFirst: new vision insurance payer

HealthFirst members will no longer have coverage through Davis Vision and Superior Vision effective 1/1/24.


Optometry and Ophthalmology specialists that perform routine vision services and medical optometry services for HealthFirst members will now need to get contracted with the new vision insurance payer: EyeMed.


Starting 1/1/24, EyeMed will handle network management, prior authorization process, member and provider services, as well as claim payments for all routine services and medical optometry services (HealthFirst members)


Providers please contact EyeMed at EyeMedInFocus.com/Join to start the xontracting process.


Below please see the list (not all inclusive) of services that require prior authorization.

Not all inclusive

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Posted in #aetna, #Medicare, #Medicareadvantage

Aetna Reimbursement Policy: Radiology Modifiers

According to provider October updates: Aetna will reduce the reimbursement rate for HCPCS radiology codes when modifiers FX and FY are appended.

Modifier FX: the reimbursement rate will be reduced by 20% for the technical component and the (technical component of a global fee) Definition: x-ray images taken by using film

Modifier FY: the reimbursement rate will be reduced by 10% for the technical component and the (technical component of the global fee) Definition: computed radiography X-ray)

Effective for any DOS on or after 1/1/2024.

Type of plans affected: commercial and Medicare lines of business plan types.

Posted in Cinga Insurance, Payer Updates, Training

Cinga updates some Preventative care Services

Changes/Updates are effective 01-01-2023


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