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  • Managing the Authorization Process. Major changes for PT, OT, and SLP under UHC and Fidelis Care payers
    FidelisCare and UnitedHealthcare enforced recent changes regarding the authorization management for PT, OT, and SLP services. Learn more about this by reading on.
What’s new

Prior Authorization Requirements to be expanded for an outpatient hospital setting
New rules are coming into play from November 1, 2019. Certain procedures now require prior-approval when performed in an outpatient hospital setting.
Update to the Reimbursement Policy for Professional Component of Radiology Services in Facility Places of Service
As of November 1, 2019, Healthfirst no longer provides reimbursements for interpretations of radiology services in certain cases. All healthcare providers should strive to understand if the changes will affect them.
New AIM Rehabilitative Program to be Implemented
Delayed AIM Rehabilitative Program has come out since November 1, 2019. These changes affect physical, speech, and occupational therapy providers.
New Utilization Management Pre-authorization Rules Coming Into Effect
There have been a number of changes implemented for Emblem Health’s Utilization Management UM pre-authorization program. The changes will come into effect from January 1, 2020.
Announcement Regarding Chiropractic & Physical Medicine Services Program
Previously announced the collaboration of Horizon BCBSNJ with American Specialty Health (ASH) will not start on January 1, 2020.
Beacon Health Options will manage GHI members.
Beginning December 1, 2019 Beacon Health Options will manage behavioral health claims for GHI members. The exact start date for this transition will be member-specific. Read on to learn more.
Business Corner
Business Corner
WCH Accomplishments
WCH Accomplishments
Your Questions Answered
What must be included in medical records when administering therapeutic/prophylactic/diagnostic injections and infusions? Is there a cut in Medicare payments expected in 2020 for Physical and Occupational Therapy?
Information For Providers
Information For Providers
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Insights
October 2019