Reimbursement Update
Posted by [email protected] on Dec. 22, 2021 / Subscribe 0
Happy Holidays to members of the American Physical Therapy Association Nebraska Chapter! Here are some additional updates regarding reimbursement for PT services in Nebraska!!
Cohere and Humana
Hopefully most of you already know this, but in case you did not, all Humana products will begin using Cohere as their pre-authorization company. Cohere has been active on the east coast region for the past 10 months. There is training available that you may access so that you know how to use the system. In fact, it is currently active and you may begin to complete prior authorizations for your existing patients that will be seen in the New Year. Please see below for useful links to access this training for prior authorizations.
During the training, they touted that in the past 10 months of this program in the 12 states for which it is active, they have only completed eight peer to peer reviews. Their goal is to have all prior authorizations completed within 24 hours. In many cases, they are averaging less than nine hours. Cohere is touting they are an all inclusive prior authorization system for pharmacy, surgery, medical care, etc. The system is designed for back office staff to complete the authorizations. However, they will definitely need input from the treating physical therapist. You may enter up to 10 CPT codes and more than one diagnosis code. You may be the initial healthcare provider in the patient’s care, in other words, direct access is still in play.
Unfortunately after talking to physical therapists in another state, how you code matters on how many visits you get approved. For instance, if you put the Z code for orthopedic aftercare for a total knee you may get fewer visits then if you use it in second place. I have heard that Cohere is very eager to ensure that the system is user-friendly and has completed multiple telephone calls with some providers in Nebraska that are already using the system.
Download a spreadsheet of additional therapy provider resources here.
United HealthCare Community Plan
Please be on the lookout for information from the APTA-NE about UnitedHealthcare Community Plan regarding some positive, but substantial changes starting 01/01/2022 for their prior authorization system. A brief tidbit is that starting 01/01/2022 with United Healthcare Community Plan patients, you will no longer use evaluation or re-evaluation codes. UHCCP and our association will update you in the very near future on further training and guidelines with this new policy.
Nebraska Total Care, Ambetter, Wellcare
Nebraska Total Care has some additional product offerings in our state and there is new training for these products. Ambetter and Wellcare will be using NIA to do pre-authorizations and there is training for this. Please sign up for the training and also for the email blasts from these products to keep yourself informed.
https://www.nebraskatotalcare.com/providers/provider-emails.html
As always, please contact me with any questions or concerns @ [email protected].
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