FLASH: No Surprise Act and Update to Changes in Utilization Management During COVID-19

The No Surprise Act Requires Providers to Update Their Directory Information

Effective January 1, 2022, federal legislation will require all providers to verify and update their profile information in order to remain listed in online provider directories.

To accurately inform our members of the ‘in-network’ status of a provider or facility, Health Alliance™ must update its provider directory within 48 hours of receiving provider information changes.

Please make sure you update or confirm that your information is accurate for all providers in your practice. Doing so will also ensure that your information in the directory is up to date.

Providers must verify certain provider data every 90 days including:

• Practitioner name and Group Name (if applicable)
• Specialty
• Address
• Phone number

Updating your information is consistent with your provider participation agreement, which requires you to update your demographic information when there are changes. Providers who do not respond to Health Alliance’s outreach every 90 days for this information may be removed from Health Alliance’s provider directory until we are able to verify their provider information. For questions, please contact your provider relations specialist.

Flash: Changes in Utilization Management during COVID-19 Emergency

In consideration of continued COVID-19 surges and the stress that this crisis places on the system, we understand the need to continue some of the flexibilities we have offered for our Health Alliance™, Health Alliance Northwest™, and FirstCarolinaCare Utilization Management process. Please note the following changes will begin effective January 1, 2022.

Inpatient Hospitalization Clinical Concurrent Review

• We will continue to waive clinical concurrent review for all acute inpatient hospitalizations, regardless of diagnosis, for a final window of extension through February 28, 2022.
• Throughout this time, we will continue to require notification within 24 hours of a hospital admission. We expect that all transfers will continue to be authorized and that we will be notified at the time of discharge. It’s critical that our members receive their benefits of post-acute care management from our care management team. We will do everything we can do to be timely and attend to skilled nursing facility discharges quickly.
• On March 1, 2022, we will reinstate clinical concurrent review and request your teams prepare now to resume communications and clinical documentation submissions to us.

Oxygen at Home for COVID-19 Diagnosis

• We will extend indefinitely, approvals for oxygen at home for Medicare Advantage and Commercial members with a COVID-19 diagnosis. The CMS flexibility will allow practitioners the option of treating their patients with home-use of oxygen during this time.

Outpatient Prior Authorization Duration

• New prior authorizations (PA) approvals will remain with a 180 day authorization date span for elective surgeries, diagnostic testing, and referrals for office visits, unless a longer timeframe is required by state or federal regulations.

We invite our provider network to visit our COVID-19 webpage for up-to-date information about the illness, our response and questions about coverage. Thank you for your care and concern for our members and the communities we serve.