Private Payer News Archive
Please select the links below for complete Private Payer articles and events of past years. View Current Private Payer News
12.12.07 Tiered and Narrow Physician Networks: How to Challenge your Profile or Placement
MAG's offices of the General Counsel and Third Party Payer Advocacy have teamed up with the AMA to disseminate a flyer giving tips on ways to challenge and improve your profile or placement.
Download Tiered Network Flyer
11.07.07 MAG Requesting Physician Reports on Health Plan Tiering:
Aetna Aexcel Designation; United Health Premium and Cigna Care
During recent months, many physicians have received letters from Aetna and United Health Care informing them whether they passed certain quality of care and efficiency measures for special designation under new or revised “Tiering” programs. These reports are often placed on the health plans’ Web site for viewing by patients and, reportedly, for health plans to move patients to higher quality and more efficient physicians.
MAG has received several reports from physicians about inaccuracies in these reports, including the addition of hospital charges in the physician profile. MAG is concerned about the misrepresentation of physician’s profiles based on inaccurate data and would like to hear from you. If you have noticed improper or incorrect data included, please send MAG copies of your designation report and background data. The information can be e-mailed, faxed or sent to:
Donald Palmisano, General Counsel, dpalmisano@mag.org
Cam Grayson, Director, Third Party Payer Advocacy, cgrayson@mag.org
Medical Association of Georgia
1849 The Exchange
Suite 200
Atlanta, GA 30339
Fax: 678.303.3732
If you have any questions, please contact Donald or Cam at 1.800.282.0224 or 678.303.9290.
03.05.07 Georgia Uniform Healthcare Practitioner Credentialing Application Form
The newest version of the Allied Healthcare Practitioner recredentialing application has been posted.
View form
11.12.06 Aetna's Urinalysis Dipstick and Pulse Oximetry Coding Change
After reviewing our policy related to urinalysis dipstick and pulse oximetry, and consulting with a committee comprised of state medical society representatives and members of the Physicians Advisory Board, Aetna is implementing the following coding change.
Beginning with claims processed as of November 12, 2006, we will pay the following codes when billed with office-based evaluation and management codes (E&Ms) appended with Modifier 25:
- Urinalysis dipstick CPT codes: 81002 and 81003
- Pulse oximetry CPT codes: 94760, 94761, 94762
- The office-based E&M codes that apply are 99201-99205, 99211-99215, 99241-99245 and 99381-99397.
All other policies will still apply and may impact the ultimate payment of the codes.
11.06.06 Important Message Regarding Aetna’s Payment Policy for Modifier-57 for Evaluation and Management (E&M) Visits
Aetna has reached an agreement with state medical societies to pay resubmitted claims for E&M visits billed with a Modifier-57 (indicating that the decision for surgery was made during the visit), for dates of service from January 1, 2005 through February 11, 2006.
When May Claims be Resubmitted? The resubmission period will begin on January 1, 2007 and will extend through April 30, 2007. Please do not resubmit these claims prior to January 1, 2007. They will be rejected as duplicate claims.
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05.26.06 Modifier–25 Dispute with Aetna Resolved
As part of MAG’s landmark settlement with Aetna in the MDL RICO litigation, Aetna was required to pay physicians for both a procedure code and an evaluation and management code, appended with a modifier–25 when billed together.
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05.26.06 Final order in the compliance dispute
View PDF
05.26.06 Codes to be reprocessed when billed with an E&M code appended with a modifier-25
View PDF
05.06 HIPAA and AMA Health Plan Complaint Forms
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04.06 Blue Cross Blue Shield of Georgia RICO Contract Addendum Received
View PDF
04.06 Aetna Agrees to E&M Payments with Modifiers
View PDF
04.06 What to Do When Submitting Your Aetna Claims
Submit impacted claims with a cover letter that includes a subject line that reads "Rework Request for E&M Codes" or call the Aetna Provider Service Center to verbally request rework of the impacted claims.