Please see the following notice sent from Aetna regarding adding referrals electronically. This was posted on Friday and I haven’t seen an update that it’s been fixed.
We’d like to let you know about issues with our Referral Add transaction. The issue is limited to members with ID numbers beginning with “1010” or “1011.”
We’re experiencing issues when Referral Add transactions are attempted for members with ID numbers beginning with “1010” or “1011.” We’re returning the error messages of “Unable to Respond” (AAA-42). In some instances, we’re incorrectly returning responses of “Out of Network” (AAA-35) or “Provider is Not a Primary Care Physician” (AAA-49).
We’ll send an updated communication once we’ve scheduled a fix for this issue.
As there’s no workaround to these issues, we ask that you post the following guidance for your clients:
On June 13th, CMS released the following changes to their HETS eligibility response. Change #2 is a big one for hospitals and long overdue.On June 13th, CMS released the following changes to their HETS eligibility response. Change #2 is a big one for hospitals and long overdue.
2. Hospital and SNF stays will be displayed separately and divided into each individual stay. Also the billing NPI associated with each hospital or skilled nursing facility will be di splayed with each stay.
3. Preventive data for the Human Papillomavirus screening will be now be supported. HCPCS code G0476 must be requested to get this data.
UHC posted this on their site a couple of days ago. Apparently they’re waiving all copays, deductibles, etc for Covid-19 services until 5/31
The health of our members and supporting those who deliver care are our top priorities, and UnitedHealthcare is taking additional steps to provide support during this challenging time.
UnitedHealthcare is waiving member cost sharing for the treatment of COVID-19 until May 31, 2020 for its Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans. We will also work with self-funded customers who want us to implement a similar approach on their behalf.
If a member receives treatment under a COVID-19 admission or diagnosis code between Feb. 4, 2020 and May 31, 2020, we will waive cost sharing (co-pays, coinsurance and deductibles) for the following:
This includes in-network and out-of-network providers. When available, we will also waive cost-share for medications which are FDA-approved for COVID-19 treatment.
During the COVID-19 health emergency, we’re working to provide resources and streamline processes so that health care professionals can focus on delivering care.
To address the short-term financial pressure caused by the COVID-19 emergency, UnitedHealth Group, through UnitedHealthcare and Optum, is taking steps immediately to accelerate nearly $2 billion in paymentsand other financial support to health care providers in our Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans. The announcement was featured in a Wall Street Journal article.
As part of our commitment to supporting you in this challenging time, we’re eliminating many non-essential administrative requests, such as surveys and data requests. We’re committed to business continuity and being there to assist you – all self-service capabilities are available, our call center is staffed and claims are being processed so you have the support you need.
This site outlines updates specific to COVID-19 as well as information on any changes to our standard business protocols. We’re monitoring the COVID-19 health emergency closely and updating this site with new information as it’s available. Be sure to check back frequently for updates.
Optum Behavioral Health will be eliminating cost shares related to virtual visits for Covid 19. Please see the announcement they released yesterday:
RE: EDI 271 Update to COVID-19 Virtual Visits for Behavioral Health Members
United Behavioral Health (dba Optum Behavioral Health) is eliminating the cost share for virtual visits related to COVID-19.
ACTION BY UNITEDHEALTHCARE:
Effective 4/3/2020, EDI 271 responses for this payer will indicate a $0 member cost share for copay, deductible and coinsurance.
Aetna just sent out the following message:
Eligibility and Benefits Inquiry (270/271):
We’ll make the following change:
These messages will be available to providers on March 28, 2020. Providers will be able to see these messages when they submit an Eligibility and Benefits Inquiry transaction with any service type code.