Optum new 90837 policy

Effective 12/1/2018, Optum/UBH is no longer requiring preauthorization for the 60 minute therapy code 90837.

NY Empire BCBS fee schedule updates

Effective April 1, 2019 Empire BCBS will update it's HMO, EPO, PPO and Indemnity fee schedules.  

This link provides more detail:  https://providernews.empireblue.com/article/attention-updated-or-new-fee-schedules-for-commercial-products-revised-date

Optum telemental health services

Optum will be aligning with CMS guidelines which state:  place of service code 02 certifies that the virtual visit meets the telemental health service requirements.

Beginning with date of service January 1, 2019, Optum will reimburse for telemental health services with the use of place of service 02 along with the required GT modifier. 

Beacon Health and MagnaCare OSCAR providers

Oscar insurance and it's affiliates have decided to contract with Optum to manage the behavioral health benefits under their EPO health plans in New York and Texas.  This change takes effect January 1, 2017.

Providers currently in the Beacon Health Options or MagnaCare networks will be receiving letters informing them of this change and their termination with Oscar effective December 31, 2016.

If you are a provider who participates with Beacon Health Options or MagnaCare AND Optum, your Oscar patients should be unaffected by this change.  You will begin sending claims with dates of service January 1, 2017 and after directly to Optum.  Providers who participate with Beacon Health Options or MagnaCare but DO NOT participate with Optum will have to contact Optum Network Management to become credentialed.  Call 877-614-0484 or email bnsproviderupdates@optum.com.

Oscar will be offering patients in treatment with non participating Optum providers (90) days of continuity of care beginning January 1, 2017.  Claims will be paid as IN network for that time period. Any further questions about the Oscar provider network changes can be answered by calling 855-OSCAR-55.

AETNA EFT ENROLLMENT REQUIREMENT

Effective January 15, 2017, Aetna will require all providers to adhere to their electronic payment policy.  This policy requires providers to enroll in an electronic payment option from Aetna directly or Payspan.   To receive EFT payments via Aetna register at https://connect.NaviNet.net/enroll. To receive EFT payments via Payspan register at www.payspanhealth.com.

HBH T2017 Network

Humana was awarded the contract for Tricare Northeast military product. This new network is accepting applications for a 2017 effective date. Those interested can contact T & T for credentialing assistance.

Getting ready for ICD-10

Most of you should now be aware that the ICD-9 code sets will be a thing of the past.  CMS has decided the old code sets are outdated and obsolete.  The ICD-10 code sets are to be utilized beginning 10/1/2015.  These new codes will provide clinicians greater detail in measuring quality, safety and efficiency of care.  They will also better identify illness and earlier warning signs of bigger issues.  T & T has provided a link for an easy transition from ICD-9 to ICD-10 codes.  The table 10.01 crosswalk gives mental health providers all the coding information needed.