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As previously communicated, effective January 1, 2015, we are introducing changes related to the application of medical and claim payment policies, as well as clinical relationship logic, for our Medicare Advantage business.
Policy notifications for Medicare Advantage HMO members are now available on the recently revised AmeriHealth Medical Policy Portal. The Medicare Advantage policy portfolio is based on Medicare coverage guidance as well as additional AmeriHealth medical and claim payment policy determinations.
Also effective January 1, 2015, the following will be applied to claims submitted on the CMS-1500 claim form or through the 837P transaction for Medicare Advantage HMO members:
- Medicare?s National Correct Coding Initiative (NCCI) editing;
- other clinical relationship logic, which is based on procedure code editing standards.
To view the Notifications for the new policies that go into effect on January 1, 2015, go to our
Medical Policy Portal and select
Accept and Go to Medical Policy Online. Then select the policy portfolio you wish to see under "Policy Notifications."
Medicare Advantage HMO policies effective January 1, 2015
Included with this edition of Partners in Health UpdateSM is a complete list of policies that will go into effect January 1, 2015, for our Medicare Advantage HMO members. Please review the list and go to our Medical Policy Portal to review each policy notification
in its entirety.
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