Medical Preferred Drug Program with Step Therapy
Effective January 1, 2021, Viva Health is adding a Medical Preferred Drug Program with Step Therapy requirements for our Commercial Lines of Business. Click here for information about the program.
Prior Authorization Update
In an effort to relieve some of the administrative burdens of our participating provider’s offices, Viva Health has recently made some changes to the prior authorization (PA) requirements for certain procedures/CPT codes. Click here for details.
Pain Management Referrals Removed
Effective 7/1/20 Viva Medicare members will no longer be required to have a Primary Care Physician referral in order to see a Pain Management physician. Here is an updated copy of our 2020 Provider Reference Guide listing the services that require a prior authorization. Click here to view.
Participating Lab Usage
Viva Health is dedicated to working with you to ensure quality care is provided at the lowest cost possible to our members. We need help from you to continue this effort. According to your provider contract, you should only refer patients to participating providers, including lab services. If you use a non-par lab, look for communication from Viva Health regarding a change in our policy that may negatively impact your fee schedule. Our participating laboratories are listed in this document.
The Centers for Medicare and Medicaid Services (CMS) finalized new opioid policies for Medicare drug plans starting on January 1, 2019. The below offers updated guidance regarding these policies.
Medicare Part D Opioid Policies:
Information for Prescribers
Frequently Asked Questions (FAQ)
Information for Pharmacists
Medicare Part D Policies for Pharmacists
Medicare Part D Policies for Prescribers
Medicare Part D Prescription Opioid Policies
Continued Affiliation Letters
Thank you for agreeing to participate in this outreach campaign. Please click here to access the secure submission site.
Attention Viva Health Provider
Viva Health has been made aware of a new scheme under which criminals are posing as pharmacists and are attempting to request fraudulent prescriptions without the doctor's or patient's knowledge. The perpetrators are contacting patients in order to obtain their primary care contact information and then sending alleged fraudulent requests through a fax-to-computer system. Examples of requests include over-the-counter medications, ointments, and diabetic supplies. Fraudulent prescriptions of the following medications have been reported:
- Diclofenac sodium solution (1.5 percent) and gel (3 percent)
- Omeprazole sodium bicarbonate
- Triamcinolone acetonide cream (0.1 percent)
- Lidocaine ointment
In our efforts to prevent fraud, waste and abuse we here at Viva Health, Inc. wanted to make you, the provider, aware of this latest scheme that could possibly affect you and or your patients. It is requested that anyone who has any information or knowledge of such activity to please report it to your security office, firstname.lastname@example.org, and your local FBI Field Office. We also encourage you to report to us, Viva Health, Inc. at (205) 558-7474
WHAT DOES THE NEW LAW MEAN FOR Viva Health, OUR MEMBERS, AND OUR PROVIDERS?
The Affordable Health Care for America Act will certainly change the health landscape over the next several years. The law’s numerous provisions are effective at different times between now and 2020 and some provisions are phased in over a number of years. Click here for the full article.
While there are many unanswered questions that should be addressed in the regulations being written now, below is a brief summary of the law’s key provisions for health plans. Please click here to read further about the changes.
UNIQUE BILLING SITUATIONS: COORDINATION OF BENEFITS
If Viva Health or Viva Medicare is secondary to a member's other insurance, Viva Health will pay the amount (i.e., copays, coinsurance) for covered services that is the member's responsibility under the primary insurance.
Where the allowed amount of the primary insurance is less than the allowed amount for Viva Health / Viva Medicare, total payment to the provider shall not exceed the amount allowed by the primary insurance. In instances where primary insurance has denied covered services for failure to follow their Plan guidelines, Viva Health / Viva Medicare may, at its discretion, deny payment as secondary coverage.
Effective March 1st, 2018, Coordination of Benefits claims for all lines of business (i.e., Commercial, Medicare) must be filed within eighteen months from the date of service in order to be considered for secondary payment.
CLAIMS WITH DRUG CODES REQUIRE NDC CODES
(Effective July 1, 2017), Viva Health will begin requiring NDC codes on all claims submitted with drug codes. Omission of the NDC code may result in a delay in payment.
To ensure a smooth transition, Viva Health encourages all providers to begin adding NDC codes to their paper and electronic claims immediately. To see more information about this change, click here.
PROVIDER NETWORK INFORMATION
Recent changes to section 100.4 of the Medicare Marketing Guidelines now require Health Plans to contact network providers quarterly to verify the information listed in the Health Plan's provider directory.
You should have received a letter from us with the information we have on record for you.
If you have any changes, please email email@example.com or call Viva Health Customer Service at (205) 558-7474 or 800-294-7780. We will then update your information on our website.
Viva Health has selected Change Healthcare (formerly Emdeon) as its electronic payment and remittance reporting provider. Change Healthcare ePayment replaces paper-based claims payments with electronic (EFT) payments that are directly deposited into your bank account. To learn more about this service and how you can sign up, download this [PDF] document.
Change Healthcare (formerly Emdeon) is Viva Health's electronic payment and remittance administrator. There is no fee to use Change Healthcare (formerly Emdeon) ePayment. Enrollment is simple and free.
By enrolling with Change Healthcare, you can accelerate your reimbursement cycle, eliminate paper based claims payments, sorting mail, and making trips to the bank. In addition to receiving payments electronically, Change Healthcare ePayment users can search, view, and print electronic remittance advices (ERAs).
To get started, contact Change Healthcare: Phone: 1.866.506.2830 Fax: 615.238.9615 Online: www.changehealthcare.com Mail: Attention – Electronic Payment Service Enrollment P.O. Box 148850 Nashville, TN 37214 NOTE: If you have signed up for EFT please expect a return email from Change Healthcare verifying your bank account information. Please respond accordingly.
Coordination of Benefits Update
Viva Health is proud to announce secondary HCFA and UB claims can now be filed electronically for all Commercial, Medicare, and Drummond lines of business. If you have any questions, please feel free to contact our Provider Customer Service department directly at (205) 558-7474.