BILLING UPDATES – DECEMBER 2016

By Tammy Bartlett, Billing Manager

UNIVERA

TWO NEW PRODUCTS AVAILABLE

Univera is introducing two new products in January 2017 which will be available to small-group community-rated customers, called Univera Access and Univera Preferred Access. Reimbursements for these products will be in accordance with their Special Programs Fee schedule.

DIAGNOSTIC MAMOGRAPHY COVERAGE MANDATE

Based on a NYS coverage mandate effective January 1st, Univera Healthcare is expanding the existing health insurance benefit for screening mammography to include diagnostic imaging for the detection of breast cancer.

The expanded services include: diagnostic mammograms, breast ultrasounds, digital breast tomosynthesis and MRI’s in addition to already covered screening mammograms. The mandate applies only to their commercial line of business.

BLUE  CROSS – PAY FOR PERFORMANCE (P4P) PROGRAM

Medicaid Managed Care (MMC) and Child Health Plus (CHP) patients and the impact on individual provider performance will be excluded from the final P4P program. Participating providers were paid incentives at the end of the third quarter of 2016 for current closed HEDIS gaps for MMC and CHP patients regardless of achievement of threshold targets. Incentive payments will be distributed by the end of the first quarter of 2017. This change in program is due to the transition of quality management of Blue Cross’s MMC and CHP members to a shared partnership with Amerigroup.

For Billing questions, please contact Tammy Bartlett at 716-348-3923 or tammyb@pracfir