Private Payer News
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06.04.10 Aetna changes reimbursement rate for mid-level practitioners
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06.03.10 Aetna releases clinical payment, coding and policy changes
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06.03.10 BCBS schedules changes to cardiology procedures
Effective for dates of service September 1, 2010 and after, Blue Cross Blue Shield says that prior authorization will be required for stress echocardiography, transesophageal echocardiography, and resting transthoracic echocardiography. This change applies only to members whose benefits require prior authorization. Servicing providers' claims will adjudicate based on the results of the prior authorization review. BCBS says a notification will be sent that includes information about the criteria and the codes that will fall under the program. BCBS said in a statement to MAG that it is doing this to ensure appropriate utilization because published clinical information shows that many physicians are not following evidence-based indications for these services.
06.01.10 National, publicly-traded health insurer CEO compensation compiled for 2006-2009
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05.27.10 AMA urges insurers to adopt new code of conduct
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05.27.10 Newly archived webinars help physicians understand and file for $350 million settlement
Physicians and practice staff can visit the AMA's Web site at www.ama-assn.org/go/ucrsettlement to view two newly archived webinars about filing a claim for the $350 million UnitedHealth Group settlement. The first webinar goes through the claims filing process step-by-step, and the second webinar provides an inside look at the lawsuit. Physicians and their practice staff also can access claims filing resources that explain how the settlement impacts the physician practice and that help maximize their recovery from the settlement.
The claims filing deadline is October 5. Physicians should keep an eye out for the claim form - the settlement claims administrator began mailing the settlement notice and claim forms to physicians on April 16.
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04.28.10 UnitedHealthcare releases H1N1 frequently-asked-questions
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04.28.10 Web site to help physicians file UnitedHealth settlement claims
The American Medical Association (AMA) has launched a new online resource at www.ama-assn.org/go/ucrsettlement to help physicians file claims in the settlement it reached with UnitedHealth Group. AMA says the settlement fund totals more than $350 million, which will be used to compensate physicians and their patients for the losses they experienced as a result of "15 years of artificially low payments for out-of-network services."
AMA says the settlement notice and claims forms were mailed to physicians on April 16, adding that the deadline for filing a claim is October 5, 2010.
Contact AMA's Practice Management Center at 800.621.8335 with questions or for additional information.
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04.21.10 Humana, Wellpoint extend coverage before reform legislation effective date
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04.16.10 CIGNA and Humana form alliance on retiree solutions for employers
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04.14.10 AMA payment policy committee prepares chart showing how private health plans intend to treat consultation codes eliminated by Medicare
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04.01.10 Several "Blues" plans reportedly working through vaccine claims issues
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03.23.10 Certain obstetrical claims denied by UnitedHealthcare will be reprocessed
The Kansas Medical Society recently notified the AMA that UnitedHealthcare was denying certain claims of physicians who only provide part of a patient's antepartum care as a result of spontaneous abortion, change of insurance or transfer to another practice. The circumstance was primarily affecting antepartum services using E&M codes and reported with modifier 25 on the same day as the ultrasound in which physicians would itemize the antepartum services by reporting E&M codes.
The AMA brought this problem to UnitedHealthcare's attention and learned that the denials were caused by a systems error that has since been corrected. According to UnitedHealthcare, physicians who received these claim denials for services rendered on or after Aug. 17, 2009 do not need to appeal or refile their claims. Instead, UnitedHealthcare will reprocess these claims. Physicians should receive corrected payments by the end of May. If you received one of these denials and do not receive a reimbursement for the denial, please contact the AMA at practicemanagementcenter@ama-assn.org so that we can address this issue with UnitedHealthcare.
Claims submitted to UnitedHealthcare on or after March 15, 2010 will be processed according to the posted reimbursement policy available at www.UnitedHealthcareOnline.com.
03.21.10 Georgia BCBS immunization administration payment issue
Official statement from WellPoint..."The related health plans of Anthem Blue Cross, Anthem Blue Cross and Blue Shield and Empire BlueCross BlueShield experienced a claims production issue in early March following the implementation of a system update. This impacted certain vaccination claims. Claims processed as of March 1 denied payment for the following immunization administration codes: 90465, 90466, 90471 and 90472. This affects most claims received from the following states: California, Colorado, Connecticut, Georgia, Maine, Nevada, New Hampshire, and New York. A system correction was put in place the evening of March 8. We are in the process of identifying the denied claims and readjudicating them so that they are paid correctly. If you received a denial and have not received a correction by the end of March, please contact your local provider service area for assistance."