UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks. The move comes after the Harris County Medical Society and Texas Medical Association expressed serious concerns about the new policy.

Blue Cross Says MOC Not Needed for BlueCompare - 02/28/2024

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.

Blues to Expand HMO Network in January; Check Your Status - 10/21/2022

Blue Cross and Blue Shield of Texas (BCBSTX) will expand its MyBlue Health HMO network to six Texas counties starting in January.

UnitedHealthcare Eliminates Copay Costs on Insulin, Other Life-Saving Medications - 08/05/2022

Some patients struggling with the cost of medications like insulin and epinephrine just got a small-but-important break from one of the nation’s largest health insurers.

Aetna Launching Patient-Facing Physician Performance Designation - 11/15/2021

Aetna Health Insurance is instituting a physician comparison system for its self-insured members in 2022, in which primary care physicians, obstetrician-gynecologists, and orthopedic hip-and-knee specialists can earn a “designation” based on their performance in two categories.

United Walks Back Payment Cut on Nonphysician Billing - 08/05/2021

Following strong pushback from the Texas Medical Association, UnitedHealthcare (UHC) has effectively reversed its payment-cutting policy change on “incident-to” billing for services performed by nonphysician practitioners (NPPs).

UnitedHealthcare Waives Cost Sharing, Extends Telemedicine for Certain Plans - 06/16/2021

UnitedHealthcare is waiving cost sharing for Medicare Advantage plan members for primary care services, and has extended access to in-network and out-of-network telemedicine visits, including COVID-19 testing and treatment, until Dec. 31 for most of its plans.

Did You Subscribe to UHC’s Premium Payment Program? Check By March 31 - 03/29/2021

TMA reminds practices that now is a good time to determine whether you are enrolled in UnitedHealthcare’s (UHC) Optum Pay Premium program, which charges a fee for access to certain electronic data. Physicians and practices who wish to opt out of the program should do so by March 31.

Revised UnitedHealthcare E&M, Prior Auth Procedures to Take Effect Jan. 1 - 12/09/2020

The Texas Medical Association’s reimbursement specialists want to be sure you see the following items in the UnitedHealthcare (UHC) December bulletin.

Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020

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 HMO Emergency Payment Review Policy Begins - 11/16/2020

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.

Collecting Payment for Noncovered Services - 10/15/2020

Can you charge a patient for a service the patient’s health insurance plan doesn’t cover? Answer: It depends.

See Blue Cross Referral Chart, Colonoscopy Coding Tips - 10/14/2020

As a result of “feedback from the provider community,” Blue Cross and Blue Shield of Texas has removed 111 procedure codes from its preauthorization requirements related to additional care categories of codes.

Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.

Charging Concierge Fees to BCBSTX Patients - 09/23/2020

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.

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.

Guide to Preventive Services Covered Under the ACA - 08/31/2016

Can you name all the preventive health services that commercial health plans must cover under the Affordable Care Act (ACA)? Here are some lists, tips, and FAQs, including links to payers’ guides.

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