WCH Insights October 2022

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INSIGHTS WCH Insights/September 2022

Insurance updates at a glance


feature story Waiver of Co-payments with Indigent Patients, Deductibles, and Co-Insurance.

insurance updates Wellcare Horizon United Healthcare Fidelis care Embllem Health NYS Medicaid Medicare

exclusive Say NO to Rein in t he Review of Systems

Your Questions Answered: Get your CEU Credit Contact Us

How can I establish EFT/ ERA connections through ECHO Health, Inc.?

business corner Medial audit: How to find professionals. Accomplishments Never stop learning


WCH Insights/September 2022

contents 1. Editors note 2. Insurance updates in-brief 3. Insurance updates (full report) 4. New policy review 5. Feature story

6. Exclusive 7. Business Corner 8. Credentialing Corner 9. WCH Accomplishments 10. Meet WCH 11. Lifestyle 12. Your questions answered


editors note

WCHWCH Insights/September Insights/October 2022 2022

"Success and all good things in life start with a genuine concern for others." The shorter and colder the days get, the more you want to show concern for those you care about. Do you remember what Mike Vance said? "Success and all good things in life start with a genuine concern for others." Whether you are at the subway station, in your office, in the park, or in the cafe where you usually have lunch, we will do our best to make you feel like you are visiting a good friend, or talking with somebody who cares about you when you are reading our newsletter. Inspired by the leaf fall and the smell of rain, we have decided to permeate the pages of our October issue with care. We will remind you of the basics, share what is new, and show the perks. We also know that many of our providers care about others, and it is the reason we see fit to tell you how to act so that this care is not regarded as fraud. Also, we paid a lot of attention to proper documentation. This is exactly the thing that can make your job burden-free, and this is what we can assist you with. Be safe and save with WCH. Take care of your practice. Taking care of you, Iryna Tetera.

Our editor, Iryna Tetera can be contacted via email: irynat@wchsb.com

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Insurance updates in-brief insurance



WCH WCH Insights/September Insights/October2022 2022


Fidelis Care

NYS Medicaid

● Wellcare reminds us of the urgent

Fidelis Care informs its providers of a new claim denial reason code that will be used when COB claim resubmission requirements are not met.

According to the New York State (NYS) Education law, certified to administer immunizations, pharmacists are authorized to administer to patients 18 years of age and older, as recommended by the Advisory Committee on Immunization Practices (ACIP) of the Center for Disease Control and Prevention (CDC).

need to check National Provider Identifier (NPI) data to ensure that accurate supplier data is displayed in National Plan and Provider Enumeration System (NPPES), as the law obliges providers to keep this data up to date.

● You should also know that Wellcare Medicare Advantage members can receive in-network care away from home, and providers will get their contractual payment rates.

More details on these two items can be found in Insurance Updates full report.

Horizon ● Horizon will no longer offer Horizon

Medicare Advantage HMO/POS or Horizon Medicare Advantage PPO plans which begin on January 1, 2023.

● During the period of active

registration in 2023, Horizon will not offer Horizon Value Access Plans.

● For coverage beginning January 1, 2023, Medicare-eligible beneficiaries who live in all 21 New Jersey counties can enroll in a Braven Health Medicare Advantage from October 15, 2022.

EX CODE: 50M Brief description: Requirements for a new claim have not been met. Long Description: COB resubmission requirements not met - missing resubmission code and/or review form.


● By the end of 2022, EmblemHealth

Medicare has updated the Physical Therapy Services CERT Alert article. Notify that the Progress Report period now shall be once every ten treatments. These updates will help get the documentation instructions to prevent improper payments.

● New requirements for genetic/

Check updates in our full report.

EmblemHealth will start managing post-acute care (PAC), replacing eviCore, for EmblemHealth members.

molecular services (HCPCS Codes: 0012M, 0013M, 0014U, and 0017) will be included in the EmblemHealth Preauthorization Lists from January, 15, 2023.

Stay tuned with Insurance Updates full report.

Learn more about this information, and get reminder details on how to bill Horizon NJ Health members in Insurance Updates full report.

UnitedHealthcare Newly enhanced General UnitedHealthcare Plan Directory searches and automated portions of the prior authorization process will be offered by UnitedHealthcare Oxford plans in New York and New Jersey from January 1, 2023.