The Payor Issue Database is found in the Members section of the KHF Intranet under the Financial menu. If you need access to the KHF Intranet, please email PayorConcerns@khfirst.com.

The Payor Issue Database contains a current list of payor and claim issues KHF is tracking on behalf of the practices. The issues were identified by your KHF network peers and escalated to KHF for research. In the Payor Issue Database, you will find:

• key dates (issue identified, most recent update, resolution date)
• claim issue descriptions
• current action
• resolution (when received)
• practices impacted

When you identify a claim issue during your EOB review, check the Payor Issue Database for known issues and their status. This may decrease your research time and offer next steps. Please encourage all billing staff to reference this helpful resource!

Is your issue not found on the Payor Issue Database? Let us know! You can add your practice to an existing issue or submit a new issue for research by emailing PayorConcerns@khfirst.com. 

Reminder! Please submit your PHI and claims examples securely. KHF can provide a secure email for you if needed.

Anthem

The original claim number must be included if submitting a corrected claim

Important reminder: The correct original claim number must be included if submitting a corrected claim - Provider News (anthem.com)

Avoid inaccurate coding combinations of laterality and diagnosis

Avoiding inaccurate coding combinations of laterality and diagnosis - Provider News (anthem.com)

Recognizing Blue High Performance Network

Blue High Performance Network - Provider News (anthem.com)

Cigna

Clinical, reimbursement, and administrative policy updates. Multiple policies referenced.

https://static.cigna.com/assets/chcp/pdf/resourceLibrary/medical/member_id_cards.pdf

Quick Guides to Cigna ID Cards

https://providernewsroom.com/cigna-healthcare/quick-guide-to-cigna-id-cards/

CignaforHCP.com and EFT Fraud Prevention

https://providernewsroom.com/cigna-healthcare/cignaforhcp-com-and-eft-fraud-prevention/

CareSource

Provider Portal Claim Submission Tool Update

ga-med-p-2735206-exela-network-notification-pdf-crdownload.pdf (caresource.com)

Medicaid

Provider Notices 4/11/2024: Georgia Medicaid Autism Services Presentation

Georgia Medicaid Common Denials Presentation

Provider Messages 4/19/2024: Secondary Claims Submission Workshops held in May 2024. Register to participate.

Provider Messages (georgia.gov)

G2211

Definition: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established).

From AAP:

• G2211 is an add-on code to Office and other outpatient services, 99202-99215.
• Used by primary care and other specialties who treat a single, serious condition or a complex condition with a consistency and continuity over a long period of time.
• CMS is emphasizing the longitudinal relationship between the practitioner and the patient.
• CMS will not allow G2211 to be used with an E/M service if modifier 25 is appended.

Tips:

• Be sure to document the medical record to support usage of G2211.
• Evaluate usage of G2211 to ensure utilization is accurate.
• Concerns on tendency to overuse the code.

Fee Schedules:

• Payors that currently have G2211 on their fee schedule: Anthem, Humana, United Healthcare.
• Code is not found on Medicaid fee schedule.

We Want To Hear From You!

Do you have billing topics, best practices, claim questions, or good news to share? Email KHF at PayorConcerns@khfirst.com.