2017 Preauthorization Changes and Clarifications In our October Newsletter, we notified you that hospitals need to notify us of any observation stays, effective January 1. These details clarify this requirement:
Medicare Advantage members sometimes request procedures that aren't covered, such as nail trimmings, from their provider’s office. Our providers were requesting members sign Advance Beneficiary Notice (ABN) letters or other waivers of liability, which have members attest that they'll be financially liable for these non-covered services. CMS does not allow use of these forms prior to the services being rendered for Medicare Advantage plans. As a result of this rule, providers were absorbing the cost of providing non-covered services.
2017 Preauthorization Changes and Clarifications In our October Newsletter, we notified you that hospitals need to notify us of any observation stays, effective January 1. These details clarify this requirement:
2017 Preauthorization and Notification Changes - Effective January 1, 2017 In addition to notifying Health Alliance for inpatient admission, facilities will need to begin notifying us of any observation stays. You must notify us within 24 hours, or the next business day if it’s a holiday. Online Claims Reprocessing Inquiries We’ve moved claims reprocessing inquiries onto Your Health Alliance for providers.
Changes Coming to Health Alliance Medicare This year, we’re offering Medicare Advantage point of service (POS) plans rather than preferred provider organization (PPO) plans. Since these members are already your patients, the transition for you will be easy.