Important Announcements
Provider Partners
October 24, 2024 – Medical Drug Benefit Changes for 2025
Effective January 1, 2025, we are making changes to the medical drug benefit coverage provided by Hometown Health and Senior Care Plus. These changes may impact some of your patients.
Starting on this date, the medications detailed in the Advanced Biosimilars – Medical Preferred Drug List(s) Jan 2025 will no longer be considered preferred within our medical benefit plan. We encourage you to consider prescribing one of the preferred medications listed on the Medical Preferred Drug List(s). Click the links below to view the lists of covered medications. These lists are also posted on the Authorization Matrices page in the “For Providers” section of our website.
2025 Medical Preferred Drug Lists – Effective 01/01/2025:
Advanced Biosimilars-first Medical Preferred Drug List Jan_2025_Commercial HTH
Advanced Biosimilars-first Medical Preferred Drug List Jan_2025_Medicare SCP
Next Steps:
- Patient Communication: Please inform your patients about the preferred medication options and the potential impact of this change on their current medications. If patients choose to continue their non-preferred medications without prior authorization, they will be responsible for 100% of the cost.
- Prior Authorization: If a patient’s current medication is deemed medically necessary, you may request prior authorization for an exception. We have an exception process in place for specific situations. To submit an exception request, please use EpicCare Link: Login (renown.org).
We appreciate your attention to this important information and your continued partnership.
October 23, 2024 – P3 Health Partners Contract Termination
Senior Care Plus, Hometown Health’s Medicare Advantage Plan, has ended its agreement with P3 Health Partners, Nevada, LLC, for provider network services to our members in southern Nevada effective 12/31/24. Senior Care Plus is continuing operations utilizing our own provider network in southern Nevada for the 2025 plan year. Please ensure that you are billing Hometown Health directly for any Senior Care Plus member services with a date of service 1/1/2025 forward. For any admissions to a facility, please ensure that you notify Senior Care Plus per our Administrative Guidelines in the specified time frames for any admissions 1/1/2025 forward.
If you have any questions or concerns, please feel free to contact Customer Service at 775-982-3232. We look forward to working with you to provide great care for our Senior Care Plus members into 2025 and beyond.
August 27, 2024 – Request for Proposal (RFP) – Statewide Air Ambulance Services
In our continuing quest to provide our members with the highest quality services at the lowest possible cost, Hometown Health is accepting Proposals for Statewide Air Ambulance Services in our Nevada service area.
Interested parties can review the Request For Proposal (RFP) below. RFP responses are due no later than 5:00 P.M. on Friday, September 27, 2024.
View the Air Ambulance RFP Here
July 17, 2024 – Office of Inspector General (OIG) Top Five Unsupported Diagnosic Codes
The Office of Inspector General (OIG) has Identified Five diagnoses that are more at risk than others to be unsupported by medical record documentation. To ensure the complete and accurate depiction of our patient populations overall health status, Hometown Health has developed an educational guide on this topic. This guide focuses on diagnosis codes deemed high risk by the CMS and OIG.
Visit our Provider Education Page to view the guide.
June 26, 2024 – New Administrative Guidelines effective August 1, 2024
Please be advised Hometown Health’s Administrative Guidelines have been updated and are available for review by clicking the link below. New requirements will be effective starting August 1, 2024.
View Administrative Guidelines Effective August 1, 2024 here.
May 24, 2024 – New Prior Authorization Requirements Effective July 1, 2024
Please be advised in order for Hometown Health to align ourselves with other payers in the market we will be instituting new prior authorization requirements consistent with other health plans effective for dates of service July 1, 2024 for HMO, PPO, EPO and Senior Care Plus plans.
Services that will now require prior authorization include select radiology and cardiac studies, based on CPT code, as well as experimental, investigational, and benefit related procedures. In addition, cystourethroscopy services and in-office surgical service will not require prior authorization when provided in-network. Please review the new requirements on our Authorization Matrix webpage.
As a reminder, turnaround times (TAT) for prior authorization requests are 72 hours for expedited requests and 14 days for standard requests.
March 20, 2024 – Contact Us Email Addresses
Hometown Health has created new email addresses to help you contact the appropriate team members on our Network Services Team. Please see the descriptions below explaining where to send specific types of inquiries. Sending inquiries to the correct email will allow for the quickest response time.
Provider Updates: ProviderUpdates@hometownhealth.com
Use the forms located here for the below updates and email them to the address above once complete:
- Provider Adds
- Provider Terms
- Provider Demographic Updates
Credentialing (Status Update Request Only): HTHcredentialing@hometownhealth.com – Please use this email address for the below topics:
- Credentialing status requests
- Credentialing effective dates
Contracting: HTHcontracting@hometownhealth.com – Please use this email address for the below topics:
- Request to join the network
- Fee schedule/contract requests
- Rate questions
- Letter of agreements
- Contract effective date questions
- Request to terminate their contract
Provider Relations: HTHProviderRelations@hometownhealth.com
- Link education
- Provider education
- Administrative Guideline inquiries
- Newly contracted provider support onboarding
March 19, 2024 – Change Healthcare Claims Submission Alternative Optum iEDI Now Live
Providers who utilized Change Healthcare to submit claims can now utilize Optum iEDI instead. Note, if you previously submitted claims through a system other than Change Healthcare, you should continue to do so and need not complete this form.
March 12, 2024 – Alternative Claims Submission Process with Optum iEDI Set To Go Live
Hometown Health’s alternative claim submission solution, Optum Intelligent EDI, also called Optum iEDI, is set to go live on Wednesday, March 13, 2023. Providers are encouraged to work with their practice management system or vendor to establish the necessary connections for claims submission using Payer ID 88023. For assistance, providers can call the Optum Support Team at 1-866-OptumGo or email them at NTW@optum.com. You can learn more about Optum Intelligent EDI here.
March 8 -2024 – UnitedHealth Group Issues Statement On Change Healthcare Cyberattack
Late Thursday, March 7, United Health Group released a statement regarding the Change Healthcare cyberattack. In it they noted the following:
- Pharmacy services: Electronic prescribing is now fully functional with claim submission and payment transmission also available as of today. We have taken action to make sure patients can access their medicines in the meantime, including Optum Rx pharmacies sending members their medications based on the date needed.
- Payments platform: Electronic payment functionality will be available for connection beginning March 15.
- Medical claims: We expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.
You can read UnitedHealth Group’s Full Statement Here
March 6, 2024 – Change Healthcare Prior Authorization Assistance
If you are a provider who utilizes Change Healthcare and you are experiencing issues submitting prior authorization requests, please email provider relations at HTHProviderRelations@hometownhealth.com and they can assist.
March 1, 2024 Provider Update – Change Healthcare Cyber Security Incident
Change Healthcare is still working to implement an alternate gateway for claims processing. We are in contact with Change Healthcare and will continue to communicate updates to providers and all stakeholders as we receive more information.
Paper claim submission is available. Providers can fax claims to the fax line 775-982-3751 or mail to 10315 Professional Circle, Reno NV 89521
March 1, 2024 – Updated Administrative Guidelines Effective April 1, 2024.
Hometown Health’s has updated its Administrative Guidelines and they will become effective on April 1, 2024. You can view the updated Administrative Guidelines and Requirements here.
February 29, 2024 Provider Update – Change Healthcare Cyber Security Incident
We would like to share the following updates to keep Hometown Health’s provider partners informed about the steps we are taking to mitigate the claim processing challenges brought about by the cyber attack on Change Healthcare:
- Change Healthcare has not provided a timeline for service restoration. It is still unknown the extent of the breach or when their systems will be back online.
- Change Healthcare has scheduled a teleconference call for Friday, March 1 at 1 p.m. (PST) to discuss an alternative gateway for claims submission.
- The Hometown Health IT Team is currently testing its own alternative claim submission option – this is still in the early testing phase.
- We will continue to update our provider partners has more information becomes available.
Hometown Health is committed to processing and paying provider claims in a timely and accurate fashion, and we appreciate your patience and partnership as we address these issues.
February 27, 2024 – Update for Providers Regarding Change Healthcare Cyber Security Incident
Hometown Health is in communication with Change Healthcare as they work through issues with their claims processing system. At this time, Change Healthcare systems remain offline. Change Healthcare is investigating the possibility of setting up an alternate gateway for claims processing. We will continue to communicate to providers and all stakeholders.
February 22, 2024 – Hometown Health Response to Change Healthcare Cyber Security Incident
Hometown Health is aware of the cyber security incident affecting Change Healthcare. We have created a Frequently Asked Questions webpage for our members. We also wanted to address the question below for providers:
Is Hometown Health accepting and processing claims?
Hometown Health will continue to process claims received in a timely manner. We recognize that many of our provider’s claims are processed through Change Healthcare as the EDI (Electronic Data Interchange) intermediary. For those provider’s impacted, we are continuing to work with Change Healthcare to monitor status updates and their ability to bring services back online. Our expectation is that when services resume, we will work diligently to process claims quickly to restore timely payments. As we continue to evaluate the length of the downtime, we will assess alternate means by which we can accept claims. If alternative means are needed we will communicate those through our provider webpage and provider email blasts.
January 5, 2024 – 2024 Fee Schedule Audit Underway
To ensure plans and fee schedules process accurately for the new year, Hometown Health is undergoing an annual audit for 2024 fee schedules and plans. As such, your office may experience a slightly longer claims turn-around time for dates of service after January 1, 2024. We do not anticipate claims holding for longer than 30 days. We ask that you be patient during this audit process and not call Customer Service for claim status updates until at least 30 days after Hometown Health received the claim. The fastest way to see the status of a claim is by using the Provider Portal LINK. We appreciate your patience as we complete the auditing work; last year the audit helped reduce claim reconsiderations by 60%.
January 2, 2024 – Prior Authorization Update
Please be aware authorization requirements may have changed for 2024. It is important the prior authorization matrix for each plan is reviewed prior to rendering care. For example, Caesars now requires a prior authorization for any lab or certain imaging that is not part of an annual exam, diabetic diagnosis, or ER/Urgent care visit. You can find all 2024 prior authorization on our Authorization Matrix page here.
