Medicare AdvantageCoverageMedium impact
2024 March Network Connection
Presbyterian Health Plan·NM · Palliative Care·Provider News
Effective date
Jan 1, 2024
We identified it
Mar 1, 2024
Summary
Presbyterian issued a March 2024 provider newsletter containing multiple updates: (1) Weight management programs (Path for Wellness) are now available at no cost to Centennial Care members with new referral pathways; (2) Hospice Value-Based Insurance Design program ended effective January 1, 2024, requiring hospice claims for new enrollees to route to Original Medicare instead of Presbyterian Medicare Advantage plans; (3) Medicaid/CHIP benefits renewal processes have changed post-COVID emergency, requiring active member renewal and affecting claims processing; (4) Multiple provider training events are mandatory or recommended throughout 2024.
Action Required
REQUIREMENTS: Immediately (March 2024): (1) Billing team must update claim routing logic for hospice claims on Presbyterian Senior Care Plan 1, 2, and 3 (HMO) — claims for patients who elected Hospice VBID on or after January 1, 2024 must now be submitted to Original Medicare, not Presbyterian. Claims for patients who elected VBID on or before December 31, 2023 continue routing to Presbyterian. (2) Update internal documentation and claim submission procedures to reflect this change to avoid claim denials or rejections. (3) Front-line staff should flag any hospice patient enrollments after January 1, 2024 for special claim routing handling. By March 21, 2024: Ensure physical health providers attend at least one Provider Education Webinar (March 21, 9-11 a.m. OR March 22, Noon-2 p.m.). Billing team should verify provider attendance tracking. By March 31, 2024: Establish process to assist Centennial Care members with active Medicaid/SNAP renewal to prevent coverage gaps. Billing team should implement protocol to identify members with pending renewal status before processing claims, as coverage discontinuation will result in claim denials. Ongoing: Train billing staff on new weight management program referral procedures (Path for Wellness) and contact information (Good Measures 1-855-249-8587) so staff can direct provider inquiries appropriately. No billing code changes are required, but workflow adjustments are necessary.