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."
Are your payments at risk? Challenged with Eligibility?
In mid-Summer 2021, the NYSCA issued a memorandum in response to a question about whether chiropractors as merchants could levy a surcharge on a patient who used her credit card to pay for her deductible, copayment or visit charge in order to offset the credit card companies processing fees often referred to as “swipe fees.”
The NYSCA Insurance Committee (The NIC) is bringing you the latest updates on CDPHP.
The NYSCA Insurance Committee (The NIC) is bringing you the latest updates on MVP.
Some of our members have contacted the NYSCA Insurance Committee regarding the processing of claims for billed services rendered to EmblemHealth's senior care members. Emblem has recently posted the following information relative to copayments:
The NYSCA Insurance Committee (The NIC) is requesting your assistance as we compile recent blinded examples of claims which have not been acknowledged or processed and in a timely manner by Cigna. These are claims which do not involve American Specialty Health (ASH), but are solely the responsibility of Cigna. Remember: Health Plans subject to the laws of New York are required to acknowledge or process clean claims within 30 or 45 days of receipt. Failure to do so can result in interest and penalties.
The NYSCA Insurance Committee (the NIC) has been in contact with American Specialties Health (ASH) to better define the benefits available to Wellcare members. Please note that All Wellcare insureds DO NOT have the insurance rider which covers all of the services listed in the ASH G9 fee schedule. NYSCA members have reported a difference in benefits when checking eligibility on ASHLink vs talking to a representative or when performing an ASHLink Inquiry.
2023 brings forth continued positive changes for doctors of chiropractic practicing in New York. Across the state certain health plans have increased fee schedules and enhanced coverage. In addition, a few third-party administrators have been eliminated, and unreasonable utilization review has been discontinued. Reasonable reimbursement and the elimination of administrative burdens affords us more time to assist our patients in achieving their goals. With significant involvement from our members, the NYSCA continues our drive to parity and fairness in reimbursement and administrative practices.
