Commercial Payers

Home > Tools You Can Use > Topics > Insurers > Commercial Payers You Can Use:Topics:Insurers:Commercial Payers<p>PAMED is leading efforts to promote policies and processes that make sense for Pennsylvania physicians and patients. Stay up to date on news involving commercial payers.</p> Healthcare Delays Implementation of Consultation Services Policy Changes<p>​United Healthcare has announced that it will delay implementation of a policy that would have ended reimbursement for certain consultation services. The policy had been scheduled to take effect on Oct. 1, 2017.<br></p> Calls for Retroactive Delay of IBC’s Modifier 25 Payment Policy<p>​Effective Aug. 1, Independence Blue Cross changed its policy on payment when Modifier 25 is used. <span><span>PAMED strongly opposes this policy change.</span></span><br></p> Reminds Providers to Use Correct ICD-10 Diagnosis Codes to Avoid Claims Denials<p>​In July 2017, Highmark issued a reminder to physicians and other providers participating in its network, advising them to adhere to ICD-10-CM coding guidelines when reporting diagnosis codes. Here's what to do if your claim has been denied due to an incorrect diagnosis code.<br></p> on the Lookout for Fraudulent Faxed Prescriptions – Here’s What You Should Know<p>​Highmark has identified a scam in which fraudulent prescriptions are being faxed to physicians. Physicians and practices should be on the lookout for any prescriptions they did not initiate.</p> to Capital Blue Cross Member ID Cards Could Impact Claims Processing<p>​Capital Blue Cross has announced that changes are coming to its BlueCard member ID cards. Here's what physicians and practices should know.<br></p> Announces It Will Not Pursue Merger with Cigna<p>National insurer Anthem announced on May 12, 2017, that it will no longer pursue a merger with Cigna. <br></p>'s Routine Immunizations Policy Changed to Reflect CDC Decision Not to Recommend Nasal Spray Flu Vaccine<p>​The CDC is not recommending the use of the nasal spray flu vaccine this 2016-2017 season due to concerns about its effectiveness. Cigna recently updated its route immunization policy to reflect this decision.<br></p> Updates Laboratory and Pathology Protocol Effective Sept. 1<p>​Beginning Sept. 1, 2016, UnitedHealthcare network physicians and other health care professionals in several states, including Pennsylvania, will be required to obtain consent from United Healthcare members before referring them to non-network laboratories and pathologists.<br></p> for Getting the Most Out of Your Payer Contracts<p>​Mary Ellen Corum, the Pennsylvania Medical Society's Director of Practice Support, provides physicians and medical practices with tips to ensure you're getting the most out of your payer contracts. This video series has two parts:</p> to Change Locum Tenens Policy, Effective Aug. 22, 2017<p>Effective Aug. 22, 2017, Highmark’s locum tenens service time frames may not exceed 60 consecutive days for Medicare Advantage or commercial networks.</p> Leap PlansAetna Introduces New Aetna Leap Plans Featuring Digital Member ID Cards In 2016, Aetna launched its new individual health insurance plans, Aetna LeapSM plans, in the Southeastern Pennsylvania market. The Leap plans feature a digital member ID card. Health Plan, Inc.