Insurance Updates

Anthem

Various Issues

As I am sure you are aware by now, Anthem has removed the requirement for prior authorization for physical medicine services performed in a chiropractic office.  You can read their statement here. However, providers have had multiple other issues arise since the first...

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AIM

As you are hopefully aware, Anthem is planning on starting a new pre-authorization process for all therapy services, 97xxx codes, on March 1st. This process will require you to register with AIM for pre-certification of these services. The KAC has had the stance from...

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Humana

96/97 Modifier

The KAC is working on issues providers are having with Humana Commercial plans.  One area we have had consistent complaints with is the 96/97 modifiers.  Humana has informed us that these modifiers are only necessary when it is an ACA compliant plan. ...

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Prior Authorization

    Humana has reinstated the prior authorization requirement on the first date of service.  This went into effect starting October 1, 2019.  Please remember to obtain authorization at the start of care and not after the eighth...

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WellCare

No Changes To PreAuthorization

WellCare sent out communication on 2/28/2019 stating there “would be an increase focus on ensuring that our providers follow our existing pre-service authorization and notification requirements.”  This does not change what services you will need to obtain...

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Passport

Modifiers

 Passport is now requiring “Always therapy codes” to be billed with the GP modifier.  This was presented in the ENews here http://passporthealthplan.com/wp-content/uploads/2019/07/Therapy-Modifiers.pdf .  Providers will need to...

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Preauthorization

 The KAC Insurance Relations Committee has some exciting news for your practice. Passport Health Plan has announced in its most recent ENews that Effective August 1st, 2019 Passport will no longer require preauthorization for treatment in your office. Over the...

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Humana Medicaid

GP Modifier

Providers have reached out to the KAC regarding denials for therapy codes (97XXX) when billing Humana Caresource.  It appears they are now requesting these codes be billed with the GP modifier.  You can rebill any denied claims as corrected and attach the GP modifier...

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Aetna Better Health

Children Under 3

We continue working with Aetna on a variety of issues including Medicare crossover claims and denials for care given to children under three.  We have sent requested information to Aetna on both these issues and will update members as soon as we have more...

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Children Under 3

  The Insurance Relations Committee recently met with ABH representatives regarding several issues our members have brought to the KAC.  At this time, ABH continues to deny claims for children under three years of age.  We discussed the...

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Medicare

Medicare ABN

As we have informed you previously, Medicare has not yet released the new ABN (Advanced Beneficiary Notice). The current ABN has an expiration date of 3/2020. CMS has indicated that we should continue to use the current form, even though it has expired until the new...

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Medicare Fee Schedule

Effective January 1st, 2020 you must bill all Medicare claims with the new Medicare Beneficiary Identifier (MBI) number. We are currently in a transition period and you can bill either the legacy HCIN or the MBI until December 31st, 2019. Starting January 1st,...

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Miscellaneous

Medicaid License Update

You will need to send your updated license to Medicaid prior to May 1, 2020. Medicaid now has a provider portal you will use to update your license. Some providers have reported this is not an easy process. The address for the Portal is located at the Partner...

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Update Your License

Your Chiropractic license renewal deadline was March 1st, 2020.  If you have not already renewed your license you can do that through the new online application by clicking here, but your renewal will be subject to a $300 fine due to missing the March 1st...

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