May 2021
Provider eConnection
IPN News and Events
that you don't want to miss!
MODA HEALTH - PARTNERSHIP CHANGE
For the past 11 years, IPN and Moda Health (Moda) have worked closely together to meet the needs of commercial members residing in Eastern Oregon. After much consideration, Moda has made the decision to transition to a direct contracting relationship with providers. 

Moda and IPN will terminate their relationship effective September 30, 2021. In the coming weeks Moda will be reaching out by mail to eligible IPN providers in the following counties to begin the direct contracting process: Ada, Adams, Canyon, Gem, Idaho, Owyhee, Payette and Washington. 

Providers outside these counties will become out of network for Moda patients. For more information, or to contact Moda, see the attached FAQs
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SPRING HAS SPRUNG A NEW TREND
IPN has experienced an increase in data discrepancies on Credentialing Applications. Discrepancies likely happen when the application is completed by the provider and the Provider Information form is completed by office staff. Avoid follow-up calls, and help IPN increase turn-around-times, by double checking data matches on all documents before submission.
RUN-OUT REPRICING
Click here to see a list of terminated groups for which IPN is processing run-out claims.

Be sure to submit claims before the run-out period ends!

For additional information about the terminated groups, contact the payor listed on the patient's ID card.
Payor News
PACIFICSOURCE COMMUNICATION UPDATES

COVID-19
Read FAQs related to Benefit and Reimbursement Policies: Benefit and Reimbursement Policy.

General Information
For news, tools, and key resources, visit pacificsource.com/ providers/medical.

CIGNA COMMUNICATION UPDATES

COVID-19
Read Cigna's interim billing guidelines and FAQs here.

Modifier 26 – Professional Component
Effective July 10, 2021, Cigna will deny CPT® codes billed with modifier 26 when applied inappropriately based on the CMS National Physician Fee Schedule. According to CMS payment policies, there are identified CPT and Healthcare Common Procedure Coding System (HCPCS) codes where modifier 26 is not applicable. This update aligns with Cigna's current reimbursement policy, Modifier 26 –Professional Component (M26) and will be applicable to all claims processed on or after becoming effective.

For more information about coverage policies, visit CignaforHCP.com > Review coverage policies.

Therapeutic Continuous Glucose Monitors 
Effective July 1, 2021, Cigna coverage for therapeutic continuous glucose monitors (CGMs) will change for customers with both Cigna medical and pharmacy coverage. Cigna will cover all components of therapeutic CGMs under the pharmacy benefit and no longer cover therapeutic CGMs filled through a durable medical equipment (DME) or medical supply vendor under the medical benefit. There is no change for nontherapeutic CGMs.

Providers are advised to send prescriptions for their patients with Cigna medical and pharmacy coverage, who also use a therapeutic CGM, to a participating retail pharmacy or to Express Scripts® Pharmacy, before medical orders expire on July 1. Additionally, beginning July 1, 2021, DME and medical supply vendors must request precertification for any therapeutic CGM orders they receive for Cigna customers. 
Just for Fun
MAY 12 : NATIONAL LIMERICK DAY
Limericks are quirky, funny poems in which the first two lines rhyme with the fifth line, and the third and fourth lines rhyme with each other. Here is a fun one written by Leona in IPN Operations:

How much peanut butter, just a smear
Not too much jelly, golly dear
Spread with a knife on a warm slice of bread
Silly me, it’s on the dog’s head
My sandwich is made, now for that glass of cheer!
Contact IPN
www.ipnmd.com
p: 866.476.1076 | f: 208.433.4605 | e: ipn@ipnmd.com