Effective September 1, 2024, the Florida Agency for Health Care Administration will terminate all registered provider IDs not enrolled with Florida Medicaid. This action is a compliance move mandated by the Centers for Medicare and Medicaid Services.
A provider must be enrolled in Medicaid and complete all requirements to continue seeking reimbursement as a treating provider for Medicaid members. The Provider Master List will outline the providers and their termination dates. Therefore, all active and registered providers can continue to provide services through August 31, 2024.
Enrollment must be completed through the Florida Medicaid Enrollment Wizard. Providers must adhere to the following key application requirements: names must match the records kept by the IRS and NPI; a unique NPI for each location; and completion of a background screening. Organizational healthcare professionals must enroll with a unique NPI number for each service location.
The following provider types are temporarily exempt because they do not have an avenue for enrollment at this time: Provider type 07, Specialized Therapeutic Services; and out-of-state provider type 16, Residential and Freestanding Psychiatric Facility. A future termination date of September 1, 2024, will be placed for provider type 97, Managed Care Treating Provider – Non-Medicaid.
Providers are strongly encouraged to enroll as quickly as possible to ensure services are not interrupted. Please go to my Medicaid-florida.com or call the Florida Medicaid Provider Enrollment Call Center at 800-289-7799 option 4 for details. This step will help to ensure Florida's Medicaid beneficiaries continue to receive needed healthcare services and meet federal requirements.
Capline Healthcare Management is pleased to share this important update from UnitedHealthcare. UnitedHealthcare introduced the National Gold Card Program, effective October 1, 2024, to reduce a significant amount of administrative burden around claims for behavioral health providers.
Under the new program, Gold Card status practices will no longer be required to submit prior authorization requests for the majority of mental health and substance use disorder services. These will be replaced by a simple Advance Notification to verify member eligibility and benefits. Towards reducing the administrative burden on providers and enabling the Provider to devote large blocks of time strictly to the patients.
Eligibility for Gold Card status is based on a practice's history of consistently adhering to evidence-based guidelines and the high approval rates for prior authorizations. An individual practice will be eligible for the Gold Card provided that it meets the following criteria: participation in at least one line of business, such as Commercial, Medicare Advantage, Medicaid, or Individual Exchange; at least a 92% authorization approval rate in two consecutive years.
Optum Behavioral Health will be administering this program and will measure practice metrics annually for eligibility. Practices will be notified of Gold Card status on or about each September with waivers effective October 1. This is a national program; however, any state statutory or regulatory requirement may supersede the national program where such laws or regulations exist or are enacted.
Please email any questions or further requests for information to Optum Behavioral Health at this address: bh_gold_card@optum.com. Capline Healthcare Management remains committed to keeping our clients updated on the latest in healthcare management. We believe the National Gold Card Program will enhance the speed and quality of behavioral health care for both providers and patients. Keep watching for more information, and get your practice ready for this program which will be implemented on Oct 1, 2024.
For healthcare providers providing services under the UnitedHealthcare Community Plan of New York, there is a significant update. As seen from August 1, 2024, all claims submitted must contain a National Provider Identifier number and appropriate taxonomy code. It is vital that your claims could be processed correctly and you could be paid in a timely way.
National Provider Identifier is a unique 10-digit number for all covered healthcare providers. Taxonomy code is a 10-character alphanumeric code defining your classification and specialization. Both are vital details that allow United Healthcare to identify you as a provider and this way match the services you are allowed to provide.
How to Obtain and Register Your NPI and Taxonomy Code
First of all, you should get your NPI number through the National Plan and Provider Enumeration System website(NPPES). You will also register your taxonomy code during this process. If you already have an NPI, make sure that your taxonomy code is updated under your specialty.
Another important information for all providers is that starting from August 1, the claims without either NPI or taxonomy code will be rejected for electronic submitters or denied for paper submitters. Therefore, double-check that both codes are included on all claims to avoid inconvenience. You can verify your NPI and taxonomy code status here.
UnitedHealthcare would like to remind you of the requirements for electronic claim submission. Instructions to help you accomplish this and technical specifications appear in the HIPAA Companion Guides for Electronic Data Exchange transactions.
Remember to update this information to ensure accurate and timely processing of your claims, as well as prompt payment for your services. Obtain and register your NPI and taxonomy code now to meet this requirement by the August 1st deadline.
For more information, please refer to the official United Healthcare provider resources and the NPPES website.
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Important Notice for GEHA Members: Changes to Dental Network Coverage Effective January 1, 2025
GEHA (Government Employees Health Association) has announced a significant change affecting its members' dental coverage. Effective January 1, 2025, GEHA members will no longer have access to dental providers within Cigna’s network. This transition means that any dental claims submitted for services provided by Cigna network dentists will be processed as "out of network" claims. As a result, members could face higher out-of-pocket costs for dental services.
Implications for GEHA Members:
GEHA’s Solution: Join the Connection Dental Network (CDN):
To ensure members continue to receive in-network benefits and minimize additional costs, GEHA encourages its members to join the GEHA Connection Dental Network (CDN). This network offers comprehensive dental coverage with a wide range of participating providers across the nation.
Benefits of the Connection Dental Network (CDN):
Action Steps for Members:
For Further Assistance:
Website: Visit the GEHA Dental Plans 2024 page for detailed information about available plans and benefits.
Customer Service: GEHA members can contact customer service for more personalized assistance and guidance on joining the Connection Dental Network.
To facilitate the process of claims and ensure correct reimbursement, the United Healthcare Community Plan of Tennessee has made amendments to the billing criterion regarding the allied health professionals who render services to TennCare members. As the adjustments to the legislation require, the following principles must be followed to claim a service:
This update emphasizes the importance of accurate provider identification on claims. By billing under their NPI number, AHPs ensure proper recognition of their services and facilitate smoother claims processing. Additionally, the requirement for an active Medicaid ID reinforces the importance of maintaining updated credentials within the state's Medicaid system.
Resources:
UnitedHealthcare Community Plan of Tennessee encourages providers to review the following resources for more information:
This requirement is consistent with the general trend prevailing in the industry because the UnitedHealthcare Community Plan of Tennessee seeks to recognize the valuable input of the AHPs by allowing them to bill under their NPI number. Proper billing has always ensured adequate reimbursement for the providers on the one hand and promoted systemic efficiency on the other.
The former is now facilitated by the updated requirements that the providers will have to follow, which means reduced denial rates and decreased periods before claims are processed. The latter is associated with the provider-centric approach that the UnitedHealthcare Community Plan of Tennessee has adopted, meaning that the billing changes will impact the consistency and quality of healthcare delivered to TennCare members.
About UnitedHealthcare Community Plan of Tennessee:
UnitedHealthcare Community Plan of Tennessee is dedicated to ensuring access to high-quality healthcare for all TennCare members. The organization collaborates with health providers and local communities to create conditions for a healthier nation.
Extensive improvements have been implemented lately to make the provision of health services more efficient. The program emphasizes its interest in developing partnerships to advance and enhance service delivery.
Source: https://www.uhcprovider.com/en/resource-library/news/2024/tn-medicaid-npi-required-for-billing.html
Washington State has introduced a new law that intends to facilitate the procedure for patients when trying to receive benefits of Paid Family and Medical Leave.
As per the new Washington PFML law, which came into force on June 6, 2024, healthcare providers are required to complete and return medical certification forms to the patient who requested them not later than seven calendar days from the day they received a request.
This implies that currently there is no specific time when healthcare providers should return these papers to the patients, which could, in turn, prevent patients from accessing the necessary benefits. Ultimately, Washington PFML law was delivered in the form of Substitute House Bill 2102, and it is pertinent to all healthcare providers who are authorized to complete PFML forms in Washington.
What are the benefits of this new law?
The Washington PFML law will be beneficial for patients who need to get the PFML benefits to recover from a serious health condition or take care of a family member. This means that they will receive a medical certification more quickly and be sent the information concerning financial help sooner. Therefore, patients should be encouraged to obtain the benefits. The following are the main demands of the new law:
What are the key requirements of the Washington PFML law?
What happens if a provider fails to comply?
Patients are allowed to seek civil relief against non-compliant providers or facilities per RCW 70.02.170. The relief can allow recovering damages or obtaining a court order mandating compliance with the law WAC 296-130.
Looking ahead
Washington State Hospital Association will continue to provide resources to help facilities stay in compliance. Information about the PFML program and medical certification forms can be accessed on the Washington State Paid Family and Medical Leave.
UniCare, a trusted name in health insurance for Massachusetts state and municipal employees, retirees, and their families, has officially rebranded as Wellpoint. This strategic move reflects the company's renewed focus on supporting the "whole health" of its members, encompassing physical, mental, emotional, and social well-being.
"Our new name, Wellpoint, signifies our dedication to a holistic approach to healthcare," said David Morales, General Manager of Wellpoint. "We recognize that health is more than just physical wellness; it's about fostering overall well-being in every aspect of our members' lives."
Wellpoint will continue to administer health benefits for over 200,000 individuals through the Massachusetts Group Insurance Commission (GIC). Despite the name change, members can rest assured that their existing network of doctors, hospitals, and healthcare providers will remain unchanged.
"We understand the importance of continuity in healthcare," Morales emphasized. "Our members can trust that their relationships with their trusted providers will not be affected by this transition."
In addition to its commitment to whole health, Wellpoint will continue to advocate for affordable healthcare access for state and municipal employees and retirees, many of whom live on modest or fixed incomes. The company aims to work with local organizations and community partners to enhance the overall health and well-being of its members.
As part of the rebranding, Wellpoint is rolling out a comprehensive communication campaign to inform members about the name change and what it means for them. Members can expect to receive new insurance cards with the Wellpoint logo, and their healthcare providers will be notified of the transition.
Importantly, there will be no changes to the health plans offered through the GIC for the upcoming plan year (July 1, 2024 - June 30, 2025). Members who are satisfied with their current plans do not need to take any action during the Annual Enrollment period.
Wellpoint's rebranding marks an exciting new chapter in the company's commitment to serving the healthcare needs of Massachusetts public servants. With its expanded focus on whole health and continued dedication to affordability and access, Wellpoint is poised to make a lasting impact on the well-being of its members.
Capline is here to streamline this change for you. Our expert team can guide you through the updated procedures, billing codes, and any other adjustments resulting from this rebranding. Don't let this transition disrupt your workflow – partner with Capline to ensure a smooth and seamless experience.
Legacy Portal To Remain Accessible For Coming Few Months
After the announcement of the portal rollout extension was addressed to healthcare providers, it was decided to extend the rollout of the new provider portal following the feedback on the challenges associated with the initial transition. While the legacy portal was previously supposed to be shut down soon, providers can now continue to manage their work through the older system for the next few months as a decision.
The need to extend the availability of the existing system is supported by user concerns regarding the new portal’s functionality and the extent to which it is integrated with current expectations. After the report of the new project’s administration expressing the recognized need for improvements, several problems were submitted, which will be addressed before the final transition of all users to the new platform.
The administration’s decision to extend the legacy portal is appreciated by most healthcare providers, largely for the fact that the administration was willing to listen to feedback and adapt the plans as needed. The extra time will allow the providers to get used to all features of the new portal themselves, limiting the extent to which their workflow is disrupted and, in the long run, making the transition smoother. Naturally, the exact details of the transition are unclear, with the ad-hoc committee only declaring that updates would be made throughout the summer.
Still, the administration’s approach to transition execution is both positive and effective. The willingness to keep in close touch with the healthcare providers and provide information about achieved results as well as any changes to the schedule will build trust between the providers and the administration and, as such, will make the implementation of the new system more successful.
The decision to extend the legacy portal's availability highlights the importance of user feedback and adaptability in the development and deployment of new technologies within the healthcare sector. By prioritizing the needs and concerns of healthcare providers, the administrators behind the new portal are demonstrating a commitment to improving the overall user experience and ensuring a seamless transition to the modernized platform.
Centers for Medicare & Medicaid Services has proposed a revival in Medicaid and Children’s Health Insurance Program managed care regulations. The final rule that was published on May 10, 2024, in the Federal Register established a compliance date of July 9, 2024. This rule aims to bolster the regulatory provisions to improve access to care, quality and health outcomes, and equity for enrollees.
This rule recognized the growing significance of managed care in Medicaid and CHIP as there was an increase in the percentage of enrolment from 81% in 2016 to 85% in 2021. Current estimates show that 74.6 % of Medicaid beneficiaries are already enrolled in comprehensive managed care organizations.
The final rule introduces a range of new standards and requirements, including:
Although the final rule is effective on July 9, 2024, some provisions have different applicability dates. Some of the requirements will be effective 60 days after the publication and the others will be phased in over the next six years. The final rule represents the new standard for Medicaid and CHIP-managed care programs. States and managed care organizations will be required to adjust their management to align with the more stringent demand.
Investments in provider networks and enhanced moving health needs will likely be primary. Other changes that may be expected are an improved process of appointment scheduling, sectoral reasoning, and a better patient-facing procedure. Similarly, the knowledge of patient experience and feedback from different states and managed care organizations will be widely shared.
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The White House has teamed up with tech giants Microsoft and Google to improve healthcare cybersecurity for rural hospitals across the U.S. It comes amid an increase in the number of cyber threats to health facilities, which has grown by 128% between 2022 and 2023, as estimated by the Office of the Director of National Intelligence.
As one of the earliest responders, Microsoft has extended discounts of up to 75% on its security solutions tailored for smaller organizations. Such independent critical access hospitals and rural emergency hospitals that have been using Microsoft products will be entitled to a complimentary year of their advanced Microsoft cybersecurity resources. The larger rural hospitals will also get access to discounts of up to 75% on Microsoft cybersecurity resources which they are still in the process of implementing.
Microsoft has announced that, besides offering discounted software, it will provide rural hospitals with free Windows 10 security updates for one year or more. Additionally, the company will deliver cost-free cybersecurity assessments, as well as training of the facility’s personnel. Interested organizations can access the program effectively immediately, and to learn more, as well as register, they can visit the website: https://aka.ms/Microsoft_Security_Rural_Hospitals.
Google, in particular, is contributing in the form of offering free advice on endpoint security to rural hospitals and nonprofit organizations. In addition to that, the company is establishing a pool of money that hospitals would be able to use to back the migration of software. Therefore, hospitals could switch to more secure approaches leveraging this funding. In addition, Google has announced that it is going to establish a pilot program with several rural hospitals. This initiative aims to help create customized healthcare cybersecurity solutions that would address the specific needs of these entities.
The American Hospital Association also reports that it has been involved in working with the White House, Microsoft, and Google to see what problems hospitals and health systems may be facing. The organization stresses that cybersecurity is particularly important for hospitals as, in most of the rural areas, they are the only providers of medical care. The American Hospital Association also states that it endeavors to ensure that the resources that hospitals will get from Google and Microsoft would be truly valuable and would address the issues faced by those entities in this sphere.
There has never been a more urgent necessity for improved healthcare cybersecurity. A series of recent attacks, most notably UnitedHealth Group’s Change Healthcare got hurt in a ransomware attack, struck the sector and served to demonstrate its weakness. Those incidents compromise patient care by causing surgeries and other procedures to be postponed and ambulances to be sent to other hospitals in many instances. White House’s initiative shows that the government acknowledges the importance of rural hospitals for their communities and the problems they experience when defending their systems against cyber attacks. It also implies that significant efforts are being made to ensure the safety of patient data and healthcare infrastructure.
The collaboration between the White House, Microsoft, Google, and the AHA represents a major advancement in healthcare cybersecurity. By providing affordable and accessible cybersecurity resources, this initiative aims to empower rural hospitals to protect themselves against cyberattacks, ultimately ensuring the continuity of essential healthcare services for millions of Americans.
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