Update: Viscosupplementation for Osteoarthritis Is a Covered Benefit for ERS Members

Immediately upon implementation: (1) Billing team must update eligibility verification procedures to check coverage status for viscosupplementation procedures through Availity Essentials or preferred vendor portal BEFORE service delivery for all ERS members. (2) Update billing system and encounter forms to flag viscosupplementation cases for pre-service eligibility confirmation. (3) Providers should be notified that viscosupplementation for osteoarthritis of hip, knee, and other joints is now a covered benefit for ERS members, but coverage must be confirmed prior to treatment. (4) Document in the member's record that eligibility verification was performed, as this does not guarantee payment—final determination occurs upon claim receipt based on member's certificate of coverage terms, exclusions, and limitations in effect on the date of service. Train front desk and billing staff that checking eligibility is mandatory before scheduling or providing these services.