Blue Shield of California has sent a notice for affiliation with ASH January 2020 for some select PPO plans and are encouraging joining ASH It is not all BS plans but specific PPO plans only. Note several plans currently do this but ASH is just the gatekeeper for medical necessity Read more…
Did you know the VA Community Care programs have timely filing limits for claims? The deadline for submitting claims for authorized care is 120 days from the date of service (DOS). With the recent transitions and changes to programs, VA has allowed TriWest to waive this timeline for a period Read more…
As Federal funding for the Veterans Choice Program ends, VA will no longer use Choice to furnish community care to Veterans. All community care will transition to the Patient-Centered Community Care (PC3) program effective June 6, 2019. The PC3 program will continue to provide access to chiropractic and acupuncture and Read more…
Where to Send Medical Documentation Changes May 1! Starting May 1, 2019, the Department of Veterans Affairs (VA) will begin requiring providers to send medical documentation to their authorizing VA Medical Center (VAMC) instead of TriWest. This change will affect providers in VA PC3 Regions 3, 5 and 6, which Read more…
United Health has made an update to billing for physical medicine codes for all plans. Now all billing for physical medicine codes 97010-97799 billed to any UHC plan must have modifier GP appended or will cause the claim to be denied. Note this prior was limited to Federal plans but Read more…
VA Community Care under Choice and PC3 will be changing to Optum Health June 2019 to manage care for veterans under the respective programs This affects only regions 1, 2, and 3. Regions 4, 5, and 6 will remain with Triwest Region 1 Connecticut, Delaware, District of Columbia, Maine, Maryland, Read more…
There have been many offices recently receiving denials for improper use of diagnosis. This is stemming not that the codes are incorrect but that they cannot be coded together on the same claim. This type of denial is due to âType 1 Excludesâ which is a diagnosis rule that does Read more…