Related Stories

TDI Fines Blue Cross $10 Million for Delays, Errors - 03/11/2020

Blue Cross and Blue Shield of Texas will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance has announced.


UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent - 02/05/2020

If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a nonemergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.


United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.


Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.


Charging Concierge Fees to BCBSTX Patients - 04/23/2019

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.


Humana Changes for 2019: Preauthorization, Notification, and Formularies - 02/27/2019

Humana has made changes for 2019 to its preauthorization and notification lists.


Coding Changes Affect UnitedHealthcare Prior Authorization Lists - 02/22/2019

UnitedHealthcare (UHC) has replaced and added procedure codes on its notification and prior authorization (PA) lists.


New UnitedHealthcare Automated Services Can Save You Time - 11/13/2018

UnitedHealthcare says it has made it easier for you to submit records, have claims paid sooner, and access pharmacy benefit information.


Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.


Humana Revises Peer-to-Peer Review - 10/18/2018

Humana has tweaked its peer-to-peer review process for prior authorization requests, giving physicians contracted with its Medicare Advantage plans another opportunity for review before filing a claim.


TDI Fines Humana Over Inadequate Network - 10/12/2018

The Texas Department of Insurance has fined Humana $700,000 and ordered the insurer to take corrective steps for not having enough in-network anesthesiologists in Harris, Bexar, and Travis counties this year.


New Precerts, Edits From Aetna - 10/05/2018

Aetna will require precertification for endoscopic nasal balloon dilation, effective Nov. 1. This is one of several changes Aetna has announced to its National Precertification List.


Humana Peer-to-Peer Review Changing for Medicare Advantage Plans - 10/05/2018

Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer to peer reviews after a medical necessity denial. Instead, the company will offer to schedule a peer-to-peer review before Humana issues the denial


United to Add Lab, Change Lab and Other Policies - 10/04/2018

Starting Jan. 1, 2019, UnitedHealthcare will use Quest Diagnostics, in addition to LabCorp, as in-network laboratories for all UHC members (excluding existing lab capitation agreements).


Cigna Website Changes You Need to Know - 08/27/2018

Cigna website changes you need to know to verify network participation, request precertifications, and other tasks.


Humana Physician Portal to Retire in October - 08/27/2018

Humana will shutter its secure provider portal on Oct. 3. To continue or begin working with Humana online, prepare now by registering for the Availity Provider Portal if your practice doesn’t already have an account.


Blue Cross HMO Emergency Payment Review Policy Begins - 08/10/2018

Beginning today, Blue Cross Blue and Shield of Texas will require some members to pay 100 percent of their medical bills if they go to an out-of-network emergency room for certain non-life-threatening conditions, company officials have confirmed.


From Blue Cross: What to Fax, Where to Find Answers - 08/07/2018

Here is a heads up on a couple of changes in Blue Cross and Blue Shield of Texas’ preauthorization and predetermination processes.


United Makes Changes to After-Hours Policies - 06/28/2018

Here's some news you can use from UnitedHealthcare.


Blue Cross to Put Off HMO Emergency Coverage Policy Until August - 06/27/2018

Blue Cross and Blue Shield of Texas will delay for 60 days a new HMO emergency care policy it had originally planned to begin on Monday, June 4.


Submitting Med Records, and More Tips From Blue Cross - 06/26/2018

Here’s some news you can use from Blue Cross and Blue Shield of Texas.


Blue Cross Payment Cut on Tap for Some Diagnostic Services - 06/19/2018

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.


Blue Cross Says MOC Not Needed for BlueCompare - 05/30/2018

Physicians across the state reacted strongly to a March 5 letter from Blue Cross and Blue Shield of Texas (BCSTX) that implied the state’s largest insurance company is now using maintenance of certification (MOC) to rate physicians. That was not the intent, the company’s president says.


TMA Seeks TDI Review of Blue Cross HMO Emergency Policy - 05/10/2018

The Texas Medical Association and 18 other Texas medical societies are asking the Texas Department of Insurance to review a new Blue Cross Blue Shield of Texas policy that could require some HMO members to pay 100 percent of their out-of-network emergency medical bills.