Recent Payor Updates

You can view the updated TCCN Payor Telehealth Grid here.

December Updates

Medicaid Update on COVID-19 Antigen Testing Code (87426)

Effective June 25, 2020, the Department of Community Health (DCH) updated the Georgia Medicaid Management Information System (GAMMIS), with the following procedure code CPT 87426, SARS-CoV-2 (COVID-19) for antigen testing.

This notification is to inform providers of a rate increase from $15.08 to $36.18 to reflect standard pricing methodology based on Medicare rates. For the claims that already have been processed and paid at the lower rate, the claims will be mass adjusted dating back to June 25, 2020.

If this service has already been rendered on or after June 25, 2020 and not processed for payment, please submit your claim(s) for processing. These impacted claims are still within the six (6) month timely filing period and will price with the new rate.

If you have questions, please contact the Gainwell Technologies’ call center at 770-325-9600 OR

1-800-766-4456 or contact us at mmis.georgia.gov.

 *Please note that the CMO rates will be based on the KHF contracts.

November Updates

Important Update: Cigna Piedmont Healthcare System Plan

We wanted to take the opportunity to inform you of a recent win with Cigna Healthcare. It was brought to our attention from many of our network practices that patients employed by Piedmont Healthcare- and insured under the Cigna Piedmont Healthcare System plan, have been experiencing claims being processed out of network. Unfortunately, many employees of Piedmont Healthcare that have chosen a Kids Health First provider as their child’s pediatrician have had to deal with this inconvenience.

We have received confirmation from Cigna earlier this week that all Kids Health First providers in our CSN will be loaded as Tier 1 providers. The estimated completion for this provider load is by November 30^th.

Cigna has also informed us that after the completion of the provider load, all patient claims that have already been submitted will be reprocessed and reimbursed as a Tier 1 provider going back to January 1, 2020. 

If your practice has been holding any Cigna Piedmont Healthcare System claims during this time period, we ask that you continue to hold the claims for the time being. We will send an official notice to all KHF practices as soon as Cigna notifies us of the completion of the provider load.

KHF would like to send a sincere thank you to all of our member practices for their hard work and assistance in helping us resolve this issue. This outcome was truly brought about by a team effort. Several practices sent us their submitted claims, reference numbers from calls with Cigna, and other official documents that helped us make our case to our Cigna and Piedmont Healthcare partners to bring about this successful outcome.

We also want to send a huge thank you to our KHF billing and finance committee members for their help and guidance throughout this process. This is a prime example of the goals we can achieve when we pull together as a network.

October Updates

10.22.20- PYA Update: HHS Revises Definition of “Lost Revenue,” Clarifies Definition of “Reporting Entity,” and Expands Phase III Eligibility

On October 22, the Department of Health and Human Services (HHS) issued revised instructions regarding permitted uses of Provider Relief Fund (PRF) payments. The legislation creating the PRF restricts its use to “healthcare related expenses or lost revenues that are attributable to coronavirus” and requires recipients to report on their use of funds. Read our detailed explanation of the HHS revisions here.

Aetna will not be covering CPT 99072.

• In Early September, the AMA created CPT code 99072 to compensate you for additional materials, supplies, and clinical staff time spent to follow COVID-19 related guidelines.
• Despite this approval, Aetna has decided that CPT 99072 will not be reimbursed as the company still considers these items and the additional time to be incidental.

Flu Vaccine Bidirectional Borrowing

Georgia VFC has announced they will allow borrowing between VFC and private flu vaccine stocks for the 2020-2021 flu season.  Please refer to the recently released guidance here.

KHF/TCCN Coding Seminar with Dr. Richard Tuck

• Presentation on 2021 Coding Updates and Changes to E & M Codes
• Recorded Video of Seminar

For more information or questions, please contact Toni Williams, Revenue Cycle Operations Manager, at twilliams@khfirst.com, 770-333-0033, ext. 216, or 678-545-5500.