To help us share our claims decision-making criteria with you as soon as we make updates, we have added a tool for you to access InterQual® criteria on our website. The Level of Care Criteria Application, also called the InterQual Transparency Tool, on the page is hosted by Change Healthcare. We use Interqual Criteria for… Continue Reading UM/ Medical Policy
NOTICE OF FORTRA DATA SECURITY INCIDENT NationsBenefits provides supplemental benefits administration services to certain healthcare plans. We were recently one of many organizations impacted by a cybersecurity attack at Fortra, LLC (Fortra)—a third party vendor we used to exchange files with some of our health plan customers. The incident impacted some health plan members’ personal… Continue Reading NationsBenefits, LLC, Cybersecurity Incident
Provider Partners Health Plans has announced a new collaboration with Health Systems Inc. (HSI) Osage Beach, MO, to offer our Institutional Medicare Advantage Special Needs Plan (I-SNP) to more than 5,800 residents of long-term care facilities serviced by HSI in 30 counties in Missouri. Beginning Oct. 15, residents of these long-term care facilities will be… Continue Reading Despite COVID Headwinds, New Plans Still See Clinical and Financial Promise in I-SNPs
In 2013 a settlement agreement was reached in the case of Jimmo vs. Sebelius class action lawsuit involving skilled care for the skilled nursing facility (SNF), home health (HH), inpatient rehabilitation facility (IRF), and outpatient therapy (OPT) benefits. The intent of the settlement agreement is to clarify Medicare’s longstanding policy that when skilled services are… Continue Reading Jimmo vs. Sebelius Training