2024 January Network Connection

By April 1, 2024: All billing and credentialing staff must verify provider directory information (physical health providers via www.phs.org/directoryupdate provider portal; behavioral health providers via www.magellanprovider.com). This is a federal No Surprises Act requirement with no exemptions. Immediately: Billing team must review updated 2024 Practitioner and Provider Manuals (available at www.phs.org/providermanuals) for changes to prior authorization criteria, medical policies, formularies, restrictions, and preferences. Update internal billing workflows and prior auth submission processes accordingly. For Medicare Advantage claims: Effective January 1, 2024, if a Presbyterian Medicare Advantage member is assigned to an Optum-employed primary care provider or participates in Optum's IPA network, Optum will now administer ALL authorization requests and hospital admission notifications. Billing team must route these authorization requests to Optum instead of Presbyterian. Verify patient PCP assignment status before submitting authorizations. All providers are encouraged to register for 2024 Provider Education Webinars (physical health: March 21-22; behavioral health: March 21-22) to understand updated policies and procedures. Failure to verify directory information by April 1 may result in claims denials due to patient eligibility verification failures.