Please see the following notice sent from Aetna regarding adding referrals electronically. This was posted on Friday and I haven’t seen an update that it’s been fixed.

Purpose:
We’d like to let you know about issues with our Referral Add transaction. The issue is limited to members with ID numbers beginning with “1010” or “1011.”

Overview:

We’re experiencing issues when Referral Add transactions are attempted for members with ID numbers beginning with “1010” or “1011.” We’re returning the error messages of “Unable to Respond” (AAA-42). In some instances, we’re incorrectly returning responses of “Out of Network” (AAA-35) or “Provider is Not a Primary Care Physician” (AAA-49).

We’ll send an updated communication once we’ve scheduled a fix for this issue.

As there’s no workaround to these issues, we ask that you post the following guidance for your clients:

• Primary care physicians: If the referral request rejects after several attempts, please direct the participating specialist to see the member as though a referral is on file. This issue should not prevent the member’s ability to seek care from participating specialists during this time.
• Participating specialists: If you’re participating in the member’s plan, try to inquire on a member’s referral. If you’re unable to find a referral, please see the member as though a referral is on file. When we receive the claim, we’ll adjudicate the claim as though the referral was on file. Contact the Member Services telephone number on the member’s ID card for help.

On June 13^th, CMS released the following changes to their HETS eligibility response. Change #2 is a big one for hospitals and long overdue.On June 13^th, CMS released the following changes to their HETS eligibility response. Change #2 is a big one for hospitals and long overdue.

1. The Home Health patient status codes has been added to the response with it’s text description. The home health service type must be requested to get this information.

2. Hospital and SNF stays will be displayed separately and divided into each individual stay. Also the billing NPI associated with each hospital or skilled nursing facility will be di splayed with each stay.

3. Preventive data for the Human Papillomavirus screening will be now be supported. HCPCS code G0476 must be requested to get this data.  

UHC posted this on their site a couple of days ago. Apparently they’re waiving all copays, deductibles, etc for Covid-19 services until 5/31

COVID-19 Treatment Update

The health of our members and supporting those who deliver care are our top priorities, and UnitedHealthcare is taking additional steps to provide support during this challenging time.

UnitedHealthcare is waiving member cost sharing for the treatment of COVID-19 until May 31, 2020 for its Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans. We will also work with self-funded customers who want us to implement a similar approach on their behalf.

If a member receives treatment under a COVID-19 admission or diagnosis code between Feb. 4, 2020 and May 31, 2020, we will waive cost sharing (co-pays, coinsurance and deductibles) for the following:

• Office visits
• Urgent care visits
• Emergency department visits
• Observation stays
• Inpatient hospital episodes 
• Acute inpatient rehab
• Long-term acute care
• Skilled nursing facilities

This includes in-network and out-of-network providers. When available, we will also waive cost-share for medications which are FDA-approved for COVID-19 treatment.

During the COVID-19 health emergency, we’re working to provide resources and streamline processes so that health care professionals can focus on delivering care.

To address the short-term financial pressure caused by the COVID-19 emergency, UnitedHealth Group, through UnitedHealthcare and Optum, is taking steps immediately to accelerate nearly $2 billion in paymentsand other financial support to health care providers in our Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans. The announcement was featured in a Wall Street Journal article.

As part of our commitment to supporting you in this challenging time, we’re eliminating many non-essential administrative requests, such as surveys and data requests. We’re committed to business continuity and being there to assist you – all self-service capabilities are available, our call center is staffed and claims are being processed so you have the support you need.

This site outlines updates specific to COVID-19 as well as information on any changes to our standard business protocols. We’re monitoring the COVID-19 health emergency closely and updating this site with new information as it’s available. Be sure to check back frequently for updates.

RE: EDI 271 Update to COVID-19 Virtual Visits for Behavioral Health Members

ISSUE:

United Behavioral Health (dba Optum Behavioral Health) is eliminating the cost share for virtual visits related to COVID-19.

ACTION BY UNITEDHEALTHCARE:

Effective 4/3/2020, EDI 271 responses for this payer will indicate a $0 member cost share for copay, deductible and coinsurance.

Example:

EB*A*IND*A6***27**0****Y~

MSG*VIRTUAL VISITS/TELEMEDICINE

Overview:

Eligibility and Benefits Inquiry (270/271):

We’ll make the following change:

• To support our policies regarding member access to telemedicine and diagnostic testing in response to the novel coronavirus (COVID-19), we’re adding the following messages to our Eligibility and Benefits Inquiry responses:
  • Telemedicine cost share
    • Medicare Advantage Plans – While the COVID-19 public health emergency is in effect, there is no cost share for a Medicare member for covered Telemedicine services performed by a PARTICIPATING provider only. Cost share is required if a member sees a non-par provider.
    • Commercial Plans – There is no cost share for a Commercial member for covered Telemedicine services regardless of provider’s participating status with the plan.
  • Diagnostic
    • All Plans – While the COVID-19 public health emergency is in effect, there is no cost share for the member for all COVID-19 and SARS-CoV-2 diagnostic testing performed in an approved laboratory location.

These messages will be available to providers on March 28, 2020. Providers will be able to see these messages when they submit an Eligibility and Benefits Inquiry transaction with any service type code.

UNITEDHEALTHCARE SYSTEM NOTIFICATION

DATE: 03/18/2020

RE: COVID-19 Claim Submissions

Effective today, UnitedHealthcare can accept EDI 837 claims with COVID-19 codes. It’s important our trading partners and health professionals are aware of appropriate coding for Novel Coronavirus (COVID-19) claims. Codes to use are as follows:

• HCPCS: U0001, U0002
• CPT: 87635

ACTION BY UNITEDHEALTHCARE:

A system update was put in place to add the COVID-19 codes, allowing us to accept claims electronically.

Happy Tuesday all. This week I’ve been thinking a lot about how every part of our lives had been changed by Covid-19. Everything from church, to work, to how we socialize with friends has been completely upended in a short period of time. These are crazy times.

My company recommended that we start working from home until further notice. This started me thinking about what other employers are doing so I figured I would ask. How has the Covid 19 pandemic changed your workplace? I know that many of you are on the front lines at doctor’s offices and hospitals. What has your facility or office changed to keep you safe and reduce the chances of exposure? Leave our responses in the comments.

CMS will have their Q1 release on Saturday March 14^th. This is a relatively small release but there is one change in particular that I wanted to bring to your attention. Currently CMS returns the next eligible date for the Pneumococcal Pneumonia Vaccination (PPV) and booster (90670 and 90732)  if you specifically request them. On 3/14, CMS will be removing that information from their eligibility response temporarily. They’re planning to change the way they return that benefit and will add it back to the response at some point in April.

When it’s added back to the response next month, they will return the dates of the last 10 times these services were provided to the beneficiary. They will also be returning the NPI of the provider that rendered the service. They haven’t released the date it will be returned to the response but said it will be “early April”.

 CMS will also be migrating to a more reliable and stable processing environment that should improve any slowness or downtime you currently experience.

They will also be changing the way they require clearinghouses to “enroll” NPIs to get access to the eligibility transactions. Unless you’re a large trading partner/clearinghouse that sends batches, this shouldn’t affect you.

UHC to Open Medicare Centers in Walgreens

https://www.unitedhealthgroup.com/newsroom/2019/2019-11-25-uhc-medicare-services-centers-walgreens.html

Humana to Layoff 800 employees by the end of 2019

https://www.usatoday.com/story/money/business/2019/10/29/humana-layoff-more-than-800-employees-several-states/2494073001/

UHC Faces CMS Sanctions on Medicare Advantage Plan

http://www.startribune.com/unitedhealthcare-plan-faces-medicare-sanction/563068872/

Priority Health and Total Healthcare to Merge

https://www.modernhealthcare.com/mergers-acquisitions/priority-health-total-health-care-merge-southeast-michigan

Anthem Suing Federal government for $100 Million in ACA payments

https://news.bloomberglaw.com/health-law-and-business/anthem-blue-cross-plans-sue-for-100-million-in-obamacare-money

North Carolina Suspends 2/1/2020 Managed Medicaid Implementation

https://www.ncdhhs.gov/news/press-releases/legislators-adjourn-without-taking-actions-required-medicaid-managed-care-dhhs

Good morning and happy November. As 2019 draws to a close, CMS as finally given a date for starting to get of HIQA, HIQH, ELGA and ELGH. They sent out the announcement below on 11/1. It sounds like they’re starting with clearinghouses first and will trickle down to everyone else later. I’ll pass on information on this as it becomes available.

” CMS will begin revoking access to Common Working File (CWF) eligibility transactions HIQA, HIQH, ELGA and ELGH effective February 1, 2020.  Submitters that aggregate transactions for otherwise disparate providers (e.g., clearinghouses, billing services, software vendors, etc.) and have both HETS and CWF based eligibility access should use HETS exclusively.

CMS will remove HIQA/HIQH/ELGA/ELGH access for these submitters by revoking role-based access for specific CMS RACF IDs. CMS will revoke access starting with high-volume aggregators. Aggregators that use both HETS and CWF based eligibility should assume they must use HETS only no later than February 1, 2020.”