How Lawmakers Express Serious Concern Regarding No Surprises Act Dispute Resolution Process

  • Nov 29, 2022

Leaders of the House Ways and Means Committee sent a letter to several agencies implementing the No Surprises Act calling for changes to the Independent Dispute Resolution (IDR) process.   Several entities have expressed concern over the IDR process defined under the legislation. The initial guidance provided by CMS instructed IDR entities overseeing the process to place emphasis...

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Medicare Draft LCDs Limiting Testing to 14 Drug Classes–Open for Comments

  • Nov 9, 2022

Six of the seven Medicare Administrative Contractors (MACs) are proposing revisions to their drug testing policies which may impact reimbursement. Five MACS, including CGS Administrators, First Coast, Novitas, Palmetto GBA, and Wisconsin Physician Services, are proposing to combine drug classes and limit testing to no more than 14 drug classes. The sixth MAC, National Government Services,...

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Remaining Waves Special Notice for Medicare Advantage Providers

  • Nov 4, 2022

Registration Dates for Remaining Code Waves – Final Wave Nov. 1, 2022 All waves, except the final wave, has been broken into smaller groups with an additional 30 days to complete that wave of test registrations. The final wave has 60 days to complete as it consists of any MDT test which has not yet been registered in DEX. The due date for submission for all tests that are defined by or bill...

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BCBS Michigan - Coding update coming next year for Medicare Plus Blue pathology claims

  • Nov 4, 2022

BCBS Michigan – Medicare Advantage Plan coding update Outpatient pathology claim – Diagnosis codes beginning with R

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RENEWAL OF DETERMINATION THAT A PUBLIC HEALTH EMERGENCY EXISTS

  • Nov 4, 2022

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective October 13, 2022, the January 31, 2020,...

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Regence BCBS – commercial

  • Nov 4, 2022

Changes effective February 1, 2023 Reimbursement Policies Administrative • Timely Receipt of Records (#145)  o New reimbursement policy stating the following about requested records: • Must be received for a claim to be processed • Should be returned by the requested date or within 10 days • Should be submitted using the method in which the request was sent (e.g., Availity Essentials...

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UHC – Hepatitis Screening – Commercial policy 2022T0548Y update

  • Nov 4, 2022

Coverage Rationale Revised list of proven and medically necessary indications for Hepatitis B screening; replaced: o “Present sexual partners of HCB-infected” with “present sexual partner is infected with HBV” o “Current and past use of injection drug; this includes those who injected once or a few times many years ago” with “current and past recreational use of injection drug(s), including...

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UHC Cell-Free Fetal DNA Testing – Commercial policy 2022T0560Z update

  • Nov 4, 2022

Effective 10/1/2022 Documentation Requirements Updated list of CPT codes with associated documentation requirements; 0327U Applicable Codes Updated list of ICD-10 diagnosis codes to reflect annual edits: o Added O35.00X0, O35.01X0, O35.02X0, O35.03X0, O35.04X0, O35.05X0, O35.06X0, O35.07X0, O35.08X0, O35.09X0, O35.10X0, O35.11X0, O35.12X0, O35.13X0, O35.14X0, O35.15X0, O35.19X0, O35.AXX0, O35...

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