FLASH: Medicare Omnipod Coverage and Prior Authorization
November 26, 2024Effective 7/1/24, Health Alliance™ added Omnipod insulin pods to the Medicare Part D formulary. Coverage of Omnipods does require Prior Authorization.
Effective 7/1/24, Health Alliance™ added Omnipod insulin pods to the Medicare Part D formulary. Coverage of Omnipods does require Prior Authorization.
After careful consideration, Health Alliance™ has made the decision to stop covering consultations billed with codes 99242-99245 and 99252-99255. Providers should bill the appropriate evaluation and management code in place of the consultation codes. Health Alliance will continue to cover any add-on codes if additional time is needed to evaluate the patient. This change will be applicable to dates of service starting on January 1, 2025. This new rule will apply to all lines of business, including group, individual and Medicare Advantage.
This is a reminder to register for the Health Alliance™ Fall Education Series that will focus on our provider portal. In our latest provider surveys, you told us that there’s a need for better understanding of our portal and the various functions that can be accomplished in it.
Each year, Health AllianceTM performs a comprehensive review and analysis around services needing prior authorization. As a result of our recent review, we are preparing to remove several items from prior authorization effective 1/1/25.
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