Highmark BCBS and Echo Health have been communicating with the provider community regarding changes to the electronic claim submission and payment/remittance processes. The NYSCA Insurance Committee (The NIC) is sending this NIC News to remind you of important deadlines to select your preferred payment method and ensure you are compliant with the revised claim submission process.
ICD-10 applies to all parties covered by the Health Insurance Portability and Accountability Act (HIPAA), not just providers who bill Medicare or Medicaid. ICD10 diagnosis codes an updated every year. Improper coding will result in a claim denial. Remember, proper coding is essential for documentation, reporting and reimbursement.
Don't miss this important deadline and instructions to file for your portion of the multi billion dollar BCBS litigation settlement.
Have you received a UHC Medicare Advantage claim denial indicating 'precertification/ authorization/ notification absent' for cases where clinical submission was not required? Did you follow the correct process? If so, we need redacted examples of cases indicating this disconnect so that Optum and UHC can address this issue.
For well over a year, the NYSCA Insurance Committee (the NIC) has reported on an antitrust class action lawsuit due to the overlap of Blue Cross Blue Shield (BCBS) plans. The settlement has been approved, including $2.8 Billion in a settlement fund. It is important to note the settlement also includes new requirements on how BCBS processes claims, communicates, and makes payments to healthcare providers. This involves all BCBS plans nationwide. Any health care services rendered over the past 15+ years are eligible to be part of this settlement.
For more information, including how to file a claim and an upcoming webinar on Friday, May 2, 2025, please click the link below:
Last week Excellus BlueCross BlueShield and Univera Healthcare sent letters to their Medicare Advantage members receiving chiropractic care. The NYSCA Insurance Committee (NIC) has spoken with numerous NYSCA doctors regarding this notice and the impact on their practices.
If you participate with UnitedHealthcare / Optum you may have received notice of the change in the aforementioned prior authorization program. Based upon the volume of calls, texts, and emails received by the NYSCA Insurance Committee (NIC), there has been several interpretations of the information published by UHC. For more information please access the following link:
Mergers. Acquisitions. Affiliations. Increasingly common and complex. These relationships may have no bearing or influence on our practice and ability to provide high quality care to our patients, while others can have a profound impact. A current affiliation awaiting approval from New York State involves CDPHP and Lifetime Healthcare.
Beginning Jan. 1, 2025, the $15 copayment for the EmblemHealth-GHl portion of the Senior Care Plan will resume. Senior Care members will be required to pay a $15 copay each time they use the health services listed below. Copays are limited to one copay per provider per date of service.
UnitedHealthcare's Prior Authorization requirements for certain Medicare Advantage members (including UHC and AARP) are now in effect. For more information, and to join us for a lunch and learn next week, please visit the UnitedHealthcare page in the members' only section of our website:
Every year there are updates to the ICD-10 codes. Listed below please find the codes most relevant to the Chiropractic profession per the cms.gov website. These changes take effect 10/1/2024.
Effective August 29, 2024, Humana is requiring prior authorization of certain Medicare Advantage members for chiropractic manipulative therapy rendered on or after August 29, 2024. The NYSCA Insurance Committee (NIC) reached out to Humana over the past week to ascertain whether prior authorization was required for Humana Medicare Advantage members in New York.
The NYSCA continues to communicate with Optum regarding the implementation of the new prior authorization program for AARP and UnitedHealthcare's Medicare Advantage members. We understand many of you have been attempting to determine the impact of this requirement on your practice and the patients you serve.
On Thursday August 1st many of you received UnitedHealthcare's Provider News email. That edition of Provider News included a section titled 'Outpatient therapy and chiropractic prior authorization required starting Sept. 1'. Due to the lack of clarity in that email, the NIC reached out to several members of Optum's team Thursday morning and afternoon to obtain more specific information about the new requirement.
As many of you have been aware, the NYSCA has been in communication with both Highmark and the NYS Department of Financial Services regarding of our member's concerns, including Highmark's implementation of a prior authorization program. Please join your fellow NYSCA members on Monday, April 29th, 8pm for an open discussion regarding our current understanding of the Highmark Prior Authorization program.
On March 27th, Highmark released a new training video for prior authorization specific to Chiropractic care. Although the process outlined is similar to the previous videos released, there are some important differences. There is additional information regarding self-funded groups as well.
As noted in our previous communication, Highmark BCBS of Western NY and Northeastern NY is implementing a prior authorization program for certain services rendered by DCs, PTs, OTs and home care providers. Prior authorization is required for applicable Highmark members for services rendered on or after May 1, 2024 (including those patients who were under care prior to that date).
As noted in our previous communication, Highmark BCBS of Western NY and Northeastern NY is implementing a prior authorization program for certain services rendered by DCs, PTs, OTs and home care providers.
As previously reported, Highmark is planning to implement a prior authorization program for chiropractic care, physical and occupational therapy, and home health care effective on April May 1, 2024. Highmark recently updated their provider news to announce "For Highmark Blue Cross Blue Shield members in commercial plans, providers will need to request authorization for outpatient physical medicine and home health services, effective April May 1, 2024."
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