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Flash – CGM Changes – Changes for Continuous Glucose Monitors

Beginning on January 1, 2024, Health AllianceTM will require durable medical equipment suppliers to bill for non-adjunctive Continuous Glucose Monitors (CGM) via pharmacy benefits through Optum for all Commercial plans.  In addition, our Medicare plans will allow for those members to receive their CGM’s either through a retail pharmacy or through a durable medical equipment supplier.  Those devices are typically billed with E2103 for the receiver and A4239 for the related supplies.

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FLASH: Skin Substitutes – Prior-Authorization Changes

Health Alliance is dedicated to constantly improving its services. Therefore, our Medical Directors and coding experts conduct an annual review of all medical policies to ensure compliance with industry and clinical best practices.

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FLASH: Health Alliance Prior Authorization Changes for 2024

Each year, Health AllianceTM performs a comprehensive review and analysis around services needing prior authorization. In our last review cycle, we removed prior authorization around ultrasound, oxygen therapy, non-urgent ground ambulance and select DME items.

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October 2023 Newsletter

As the leaves change, our gratitude never does. Autumn is a time of change. The weather’s getting colder, daylight is fading quicker into evening dusk and the trees are showcasing brilliant colors in the weeks before losing their leaves for another winter ahead. While nature is in a constant state of change, our gratitude for you never is. Across the seasons, you and your staff never rest as you provide our members the best in compassionate, world-class care. And that’s why – all year round – we’re simply beyond thankful for all that you do. As you enjoy the beauty of nature this autumn, please know how deeply grateful we are for your partnership.

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FLASH: OSF Leaving Triple Option Plans

Recently, the contract between OSF HealthCare and Health Alliance™ came up for review between the two organizations. Health Alliance strives to offer a competitive product in the market with a tiered structure where there is reduced cost-sharing for patients when they see a Tier 1 provider. As such, there are certain contract terms that must be met to keep the product competitive in the market.

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