Private Payer Round-Up, July 2012

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at for help.

Aetna Awarded Medicare Advantage Contract by TRS: The Teacher Retirement System of Texas (TRS) has awarded Aetna its Medicare Advantage contract, effective Jan.1, 2013. Aetna currently administers the fund’s group retiree plan, TRS-Care, which covers more than 226,000 retired public school employees and their dependents. Aetna will enroll eligible TRS-Care participants in an Aetna Medicare Advantage plan that it says offers lower premiums and a “significantly” lower deductible than TRS-Care.

United Healthcare Services (UHC) is offering free webinars for physicians regarding the transition to UHC from Blue Cross and Blue Shield of Texas as the third-party administrator for HealthSelect of Texas, health care plan the state’s health care plan managed by the Employees Retirement System of Texas. The changeover is effective Sept. 1, 2012. 


Mandatory compliance communications — Physicians contracted with Humana Medicare Advantage plans should have received a communication from Humana requesting that they confirm online their receipt and understanding of certain training and certification materials as required by the Centers for Medicare & Medicaid Services (CMS). The confirmation is part of your contractual obligation to Humana. For details, see Humana’s YourPractice for June 2012. 

Web tool enhancements — look for these new features on

  • Secure messaging tool: If you access secure emails via’s secure provider website (registration required), you will now need to access those messages using a new secure messaging tool. The tool is located in the same area as before. After logging into the secure website, choose “Resources,” then “Message Center.” There is a one-time registration process to access the new secure messaging tool.
  • Eligibility and benefits tool: Humana has incorporated suggestions from health care providers, including care alerts on the eligibility and benefits summary display screen, and more categories of care on the inquiry screen. 
  • Claims attachment tool: You may submit claims attachments in the following file types: JPEG, TIF, GIF, and PDF.  
  • Referral and authorization tool: You now may to attach up to 10 documents with referral and authorization requests.

Drug prior authorization — Humana requires practices to fax standard requests for prescription drug authorizations, rather than submit them by telephone. Expedited requests and status calls may be handled by phone. You can obtain prior authorization request forms online or by calling (800) 555-2546. Fax the completed forms to (877) 486-2621. Read more information about filling out the forms, exceptions, and more.


Precertification updates — Cigna’s precertification list (July 2012) reflects new codes that the American Medical Association and CMS released on July 1. On Aug. 6, 2012, Cigna will update its list of CPT and HCPCS codes to include additional codes (including pharmacy codes) that will require precertification and to remove 10 codes, as follows: 

  • Medical codes that will no longer require precertification: 0050T, 27437, C9273, C8729, S3905, 0160T, 27438, C9728, L8699, S9024
  • Medical codes being added to the precertification list: 20527, 65771, L1840, L8042, L8049, 22520 81223, L1844, L8043, S0800, 22522, 96446, L1846, L8044, 26341, 0192T, L8040, L8046 65767, E0604, L8041, L8047
  • Pharmacy codes being added to the precertification list: J2503, C9276, J9033, J2778, C9399, J9179

NDC requirement on specialty medication claims — Starting Sept. 1, 2012, Cigna will require the National Drug Code (NDC) on some claims in addition to the HCPCS code for some specialty medications. This will help support more affordable care by promoting the use of safe and lower-cost drug therapies. For the injection codes J0725, J1830, and J2941, submit both the HCPCS code and NDC when all of the following apply:

  • The patient’s plan requires precertification for outpatient services,
  • The place of service is the physician’s office or the patient’s home, and
  • Cigna is the primary payer.

Explanation of payments for patients with GWH-Cigna ID cards — In March, you may have noticed a change in the appearance of the explanation of payment (EOP) statements you received for care provided to patients with GWH-Cigna ID cards. New features are: 

  • Key information, such as the check number, date, and dollar amount, is in the top right corner.
  • “Contact Us” details are in the top right corner, including the current URL: www.
  • “Member” is now “subscriber.”
  • “Group name and number” has changed to “Account name and Account number.”

If you have questions about EOP changes, call (866) 494-2111.

Details about the above Cigna updates are in Cigna’s Network News (PDF)

Published July 31, 2012 

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