I’m completely fascinated by the thought of a pharmacy chain buying a major payer. I read somewhere that they want to add small walk in clinics to all the stores and steer people there for services like preventive service and other non urgent treatments.
CMS released images of the new Medicare card along with some details on the new design. The release is still several months away but they’ve started sending out marketing materials already. I really wish some of those materials would include telling them to stop carrying their old card.
Details of the new design:
Have you see the “Guard Your Card” commericials?
CMS will be releasing some changes on November 4th for the HETS eligibility response that are pretty significant. I’ve summarized the items below and included a link to the full document. Numbers 3, 4, and 6 were particularly interesting to me.
CMS 270/271 Release Notes November 4th
1. The following new preventative benefits will be added when requested in the inquiry.
81528 – Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result
G0297 – Low dose CT scan (LDCT) for lung cancer screening
G0442 – Annual alcohol misuse screening, 15 minutes
G0443 – Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
G0472 – Hepatitis C antibody screening, for individual at high risk and other covered indication-
G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes
G0475 – HIV antigen/antibody, combination assay, screening
2. New insurance type codes added for Medicare Secondary payer response
• AP – Auto Insurance Policy – this indicates a No-Fault Medicare Set-Aside Arrangement (NFMSA)
• LT – Litigation – this indicates a Liability Medicare Set-Aside Arrangement (LMSA)
3. An indication of QMB enrollment will be returned for beneficiaries if CMS shows them enrolled during certain periods based on the dates requested.
4. All admissions during a date span will be returned individually. Previously if the beneficiary had multiple admissions during a date span, the response would show the admissions as one admission.
5. Hospice information will only be returned for beneficiaries with Part A entitlement.
6. The response will indicate if the beneficiary isn’t eligible for preventive codes G0402, G0403, G0404, and G0405.
7. Preventive information won’t be returned for beneficiaries that have QMB for the dates requested.
All of the BCBS plans have been posting announcements about the new alpha/numeric prefixes that they’re going to be rolling out next year. Below is the announcement that Anthem put in a recent newsletter:
New member ID prefixes coming in 2018 The Blue Cross and Blue Shield Association (BCBSA) assigns member ID prefixes for all Blue Cross and Blue Shield branded Plans – Anthem Plans as well as non-Anthem Plans. There are a limited number of unused three-character, alpha only prefixes remaining, and they are expected to be exhausted in the 2nd or 3rd quarter of 2018. When that happens, the BCBSA will begin assigning prefixes that contain a combination of letters and numbers, or alpha-numeric prefixes.
What does this mean to you?
Note: Current three-character, alpha-only prefixes will not be affected by this change. Current prefixes will still be valid once the new alpha-numeric prefixes are issued, unless there is another need to change or remove a prefix currently in use.
I’ve been seeing a lot of emails about this lately so I thought I would share some of the information I’ve received recently. This is a bulletin CMS sent recently:
The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) in April 2018. You may need to change your systems to:
UNITEDHEALTHCARE SYSTEM NOTIFICATION
Re: Referral Required Message to Display on Eligibility and Benefit EDI Response (271) Transactions
UnitedHealthcare is adding an Electronic Data Interchange (EDI) referral indicator to eligibility response (271) transactions as of Mar. 1, 2017, for all lines of business.* If the member is enrolled in a plan requiring a referral from their Primary Care Physician (PCP) before seeing a network specialist, the following message should appear notifying the care provider: PCP to submit a specialist referral. Referrals should be requested electronically as a 278 EDI transaction.
The following steps outline the changes UnitedHealthcare is making to the 271 transaction (005010X279A1):
1. EB11 Authorization or Certification Indicator in the 2110c and 2110d loop include the Y value to indicate preauthorization/notification/referral is required at the plan level.
2. For the 2110c and 2110d, MSG segment, include the referral reminder message: “PCP to submit a specialist referral.”
Contact UnitedHealthcare EDI Support at 800-842-1109 if you have any questions. Please forward this communication to your customers as needed.