Tag: #Medicareadvantage

Find medical billing and coding guidance for Medicare Advantage Plans (various insurance payers)

Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP NY – Home Health Approval Process-New 2021

Posted on by KR2Medical Billing

This new process is an auto-approval, that would streamline the first time initial HH request.

This policy change applies to all MVP Medicare Advantage Members requiring HH admissions.

Provider will have to send in their request through naviHealth.

The providers will receive 10 pre-approved visits, which would include the Start of Care (SOC) visit.

Starting 01/01/2021- naviHealth will utilize Change Healthcare’s InterQual home health criteria for continued stay requests, additional services, and recertification’s.

Education:
• naviHealth will provide educational webinars (Details to come)
What will the webinars include?
• An overview of the new HH auto-approval process
• A detailed look at the revised naviHealth HH authorization request form
– There will be an opportunity for questions & answers
Who should attend?
• HH agency billing/Insurance areas
• HH agency intake department manager

Please contact the naviHealth Senior Clinical Manager, Monica Bean at mbean@navihealth.com with any questions.

Source: MVP fax Provider Communications.

Posted in Insurance, Training, Updates

EmblemHealth (NY) COVID-19 Vaccine and Monoclonal Antibody Infusions Policy

Posted on by KR2Medical Billing

Effective 11/09/2020 the following are the guidelines for COVID-19 Vaccine and Monoclonal Antibody Infusions for various EmblemHealth Product lines:

  1. Commercial Plans- EmblemHealth will cover the costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. Reimbursement will be based on CMS published rates. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.
  2. Medicare Advantage Plans- charges for administrating the COVID-19 vaccine should be billed to your local MAC (Part B). The MAC will reimburse claims for Medicare members with no cost share for the remainder of 2020 and through 2021 If the provider will bill the claims to EmblemHealth the charges will be denied and the provider will be informed that the charges need to be submitted to the local Part B MAC. (If you are a provider located in NY the local Part B MAC is NGS- national government services).
  3. Medicaid Plans- EmblemHealth will cover costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.

Partial List applicable to this reimbursement policy:

For the complete policy and the complete list of applicable codes, please click here to visit the policy.

Posted in Insurance, My services, Training, Updates

Aetna: New Medicare Advantage Plans in North Carolina, South Carolina and Tennessee- 01/01/2021

Posted on by KR2Medical Billing

As of 01/01/2021- there are 2 new HMO plans that will be available in NC, SC and Tennessee: These plans are Aetna Medicare ValueSM Plan (HMO) and Aetna Medicare Value Plus Plan (HMO)

These plans will require to choose a PCP. However, they will NOT require a referral to see a specialist. This information will be on the member cards, as indicated by the red arrow below:

The following is the list of the plan types:

Supplemental Benefits: NOT all plans will have these available

  • Dental (preventive and comprehensive)
  • Over-the-counter (OTC)
  • Hearing Aids
  • Post hospital discharge meal delivery
  • Telehealth

Additional Information:

  • All members must select a primary care physician.
  • There is no referral requirement for specialty care.
  • Participating providers can submit pre-authorization requests through our provider portal, or they can also fax the request or call it in to the Provider Service Center.
  • These plans include pharmacy Part D coverage.

Note: No out-of-network benefits exist for these plans unless the member follows the approval process. They can start this process by contacting Member Services directly.