Humana Exits Employer Group Commercial Medical Insurance
Humana Inc. made an important announcement today regarding its future business focus. The company has decided to discontinue its involvement in the Employer Group Commercial Medical Products business, which includes various medical plans such as fully insured,...
GA Governor Signs Law Banning ‘Medical Title Misappropriation’
Governor Brian P. Kemp of Georgia has signed a new law that will come into effect on July 1st, which requires medical specialists to have proper credentials to support their claims. Georgia Senate Bill 197, known as the "Health Care Practitioners Truth and...
Optum to Manage Provider Enrollment for NC Medicaid
Optum selected to oversee the enrollment, credentialing, and data management for more than 90,000 healthcare providers serving patients in the state’s public health programs.
Health Data Privacy & Telehealth
In response to the increased utilization of telehealth due to the COVID-19 pandemic, there has been growing concern over how telehealth vendors and practitioners protect and use health data. Policymakers and regulators have proposed or implemented policies to address...
2023 Final Rule for Marketplace
The Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2023 Final Rule for Marketplace health plans has a Network Adequacy provision regarding telehealth services. As of January 2023, HHS requires health plans to identify and...
What Is Provider Enrollment
Provider enrollment refers to the process of becoming a participating provider in a health insurance plan or network. This process is typically required for healthcare providers, such as doctors, nurses, and other medical professionals, who wish to provide care to...
Michigan Medicaid Program Terminates Relaxed Provider Enrollment Rules
The Michigan Department of Health and Human Services (MDHHS) has issued Bulletin Number MMP 22-38 to re-establish provider enrollment and revalidation rules. Bulletin MSA 20-28 was issued in April 2020 to relax enrollment requirements and to suspend the provider...
CMS Revalidations Restarted
In October, CMS began activities that were halted due to the public health crisis including: Application FeesCriminal background checks associated with fingerprint-based criminal background checksProvider/Supplier Revalidation Providers and suppliers that are required...
UHC Out-of-network provider enrollment
UnitedHealthcare has introduced a new online portal allowing out-of-network providers to electronically register their taxpayer ID numbers and practice demographics. Prior to submitting claims to UnitedHealthcare as an out-of-network provider, the following...
Physician Assistant Medicare Payment Rules Updated For 2022
On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released its Final Medicare Physician Fee Schedule for 2022 (the “Final 2022 MPFS”), revising certain payment policies for services provided to Medicare beneficiaries by healthcare...
Payer Credentialing and Telehealth (Part 2)
It is a New Normal Commercial payers have been forced to accept telehealth services as an effective method of healthcare. Prior to the public health crisis, it was often difficult to obtain a participating provider contract from payer networks for telehealth services....
Telehealth and Credentialing Part 1
Telehealth is a vital service to any medical practice today. The nuisances of credentialing for this service can cause headaches and roadblocks in getting payer contracts.
