Important Announcements

Provider Partners
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.

December 5, 2023 – 2024 Administrative Guidelines

Hometown Health has updated its Provider Administrative Guidelines for 2024.  Changes to to the Current Administrative Guidelines will be in effect on January 5, 2024.

You can view the 2024 Administrative Guidelines here.

November 15, 2023 – Provider Newsletter Now Available

See Hometown Health 2023 Provider Updates here.

October 30, 2023 – Senior Care Plus D-SNP Model of Care Training

Senior Care Plus has developed training materials for providers who care for Senior Care Plus members with special needs.  The Senior Care Plus D-SNIP Model of Care training materials are now available.  The training materials included a description of the D-SNP population, Care Coordination. the Provider Network, and the Model of Care Quality Measurement and Performance Improvement Initiatives.  View the D-SNP Model of Care Training document here.

October 20, 2023 – Important Referral Requirement Changes for 2024!

For small-group, association health plans and large-group HMO plans, PCP referrals will no longer be required for a patient to see a specialist. You should be prepared to see patients from these plans without the need for referrals.

Specialist Referrals May Still Apply:

  • While PCP referrals are no longer needed for the plans mentioned above, it’s essential to note that specialist referrals may still be required.
  • As healthcare providers, you should continue to communicate with specialists when referring patients to ensure a seamless care transition and coordination.
 
October 17, 2023 – Center of Excellence Reminder!

If there are services a member needs that cannot be performed in Hometown Health’s direct network in Nevada or at the University of Utah, and you need to refer a member to a Center of Excellence such as Stanford or UC Davis, the service will only process at the member’s in network benefit cost share if authorized as in-network by Hometown Health. If not authorized as in-network, the member will be liable for the out of network cost share.

October 17, 2023 – Important message for Provider Partners regarding Friday Health Plan Claims

On June 12, 2023, the Eighth Judicial District Court of Nevada ordered Friday Health Plans of Nevada (FHP-N) into receivership. Receivership is the first step toward liquidating the company’s assets.

August 31, 2023 was the last operating day for FHP-NV. If you performed services for Friday Health Plan members on or before that date and have not yet submitted a claim, you are strongly encouraged to do so AS SOON AS POSSIBLE.

Friday Health Plans of Nevada is a former Hometown Health leased-network client. Hometown Health wants to protect provider partners from the uncertainties that come with receivership – and we believe the prompt filing of all FHP-NV claims gives our provider partners the best opportunity to be properly and promptly reimbursed.

The state of Nevada has set up a website for more information at fridayhealthplansofnevada.com

August 3, 2023 – Nevada Department of Insurance Announcement Regarding Friday Health Plans 

View the DOI’s Press Release regarding Friday Health Plans titled: “Important Information for Members on Friday Health Plans of Nevada Members Special Enrollment Period Offered to Find New Coverage.”

June 9, 2023 – No Surprises Act Quarterly Attestation Reminder

Hometown Health has partnered with Better Doctor to fulfill the regulatory requirements of the No Surprises Act to ensure providers are attesting to their directory information on a quarterly basis. Your office will receive quarterly requests directly from Better Doctor to complete attestations. Providers with outdate information may be dropped from our provider directories. We appreciate your collaboration in keeping our directories up to date for our members.

January 26, 2023 – Fee Schedule Audit Underway

Hometown Health has invested in an outside auditing firm to review and ensure our 2023 plans and contract fee schedule builds are accurate. As such, your office may experience a slightly longer claims turn-around time for dates of service after January 1, 2023. We do not anticipate claims holding for longer than 30 days. We ask that you be patient during this audit process and ask that you not call Customer Service for claim status updates until at least 30 days after Hometown Health received the claim. We appreciate your patience as we complete the auditing work to ensure you are paid accurately throughout 2023.

January 19, 2023 – Hometown Health CAA Compliance Notification

This is to inform you that Hometown Health is in compliance with the Consolidated Appropriations Act (CAA) which was signed into law on December 27, 2020. The CAA includes a new prescription drug reporting requirement.

  • For 2020 and 2021 reporting due on 12/27/2022, Hometown Health has sufficient information to submit P2, D1, and D2 files and has coordinated with our Pharmacy Benefit Manager (PBM), Maxor, to submit D3 – D8 files for all of our fully-insured employer groups.
  • For 2022 reporting due 06/01/2023, reporting of the average monthly premium paid by members and the average monthly premium paid by employers will be required. These fields were waived for 2020 and 2021 reporting. We will be exploring next steps for these elements in early 2023 to enable Hometown Health to continue submitting on behalf of fully-insured groups. As we determine the appropriate actions we will reach out to our broker partners and fully-insured groups to close the gap on these two reporting fields.
August 19, 2022 – Hometown Heath Partners with University of Utah

Hometown Health is pleased to announce a new partnership with the University of Utah effective Aug. 1, 2022. As our new preferred partner, this grants in-network access to members of Hometown Health’s Commercial, TPA and Senior Care Plus plans for all University of Utah services, including but not limited to cancer care, neurology and cardiology. Out-of-state referrals may now be directed to the University of Utah. To learn more about University of Utah, click on the “University of Utah” link at the top of the Hometown Health Provider Directory page here.

September 29, 2022 – Friday Health Plan Network Lease Termination
Hometown Health and Friday Health Plan recently announced that they have mutually agreed to end their provider network lease agreement effective June 30, 2023. Friday Health Plan members will continue to access care through the Hometown Health provider network, and Hometown Health network providers should continue to service Friday Health Plan members through the June 30,2023 termination date. Friday Health Plan is currently working to develop their own provider network to service Friday Health Plan members for dates of service of July 1, 2023 and beyond.
September 1, 2022 – Hometown CEO David Hansen Set To Retire
In a press release yesterday, Renown Health announced that David Hansen, Hometown Health CEO, will retire on October 7, 2022. The release also noted that Bethany Sexton, MBA, will assume the role of CEO of Hometown Health effective September 12. 2022. You can read the full press release here.
August 30, 2022 – Legacy HMO Plans Employer Group Update
At the beginning of 2022 we sent out a list of employer groups who were on legacy HMO plans and excluded from the below limitations. The updated list of employer groups below remain on legacy HMO plans and are still excluded from the a limitations listed below
Please note, the below employer groups do not require a referral to see a specialist and are able to see a non-Renown primary care provider until the group renewal.
  • CGI, Inc
  • Clasen Quality Chocolate
  • Donor Network West
  • Sheet Metal Workers
  • Western Surgical Group
Commercial Employer Group HMO 2022 Network and Plan Changes (The above employer groups are excluded from the limitations below.)
  • New large group plans and new and existing small group plans must use a Renown primary care
    provider or Geriatric Specialty Care provider* (community pediatricians may be used).
  • Providers/facilities limited to Washoe, Carson, Lyon, Douglas and Storey County
    (ancillary providers such as DME and diabetic suppliers outside of the above counties can still be used,
    benefit authorizations as required by each plan still apply).
  • All services with the exception of urgent, emergent and prior authorized higher level of care must be done within the counties specified above.
August 19, 2022 – Hometown Heath Partners with University of Utah
Hometown Health is pleased to announce a new partnership with the University of Utah effective Aug. 1, 2022. As our new preferred partner, this grants in-network access to members of Hometown Health’s Commercial, TPA and Senior Care Plus plans for all University of Utah services, including but not limited to cancer care, neurology and cardiology. Out-of-state referrals may now be directed to the University of Utah. To learn more about University of Utah, click on the “University of Utah” link at the top of the Hometown Health Provider Directory page here.
 
July 14, 2022 – New Durable Medical Equipment Providers for Senior Care Plus

Senior Care Plus is pleased to announce we have added new Durable Medical Equipment (DME) Providers to our network to better serve our members. See our updated Durable Medical Equipment page on the Senior Care Plus website to learn more.

May 24, 2022 – Claims Payment Update
We have identified a common issue with member demographics that is causing claims to be rejected at the clearinghouse before routing to Hometown Health for payment. For your claim to process, please ensure that your patient’s member number, name, address, and date of birth align with HTH’s member records in Tapestry Link. If you need to check eligibility or look up member demographics, Tapestry Link is available to all providers for this purpose.
Additionally, we have  implemented a detailed claims rejection messaging system.  If a claim is rejected upon loading, your office will receive a 277 report listing the reason(s) (incorrect demographic, eligibility, etc.) the claim was not valid. Once you’ve received the rejection reason, you may submit corrected claims, but please do not do so prior to receiving the rejection reason report as the claim will reject again as a duplicate.
February 4, 2022: Provider Payment Update – Friday Health Plans
We are currently upgrading our technology which has caused unforeseen delays in claims pricing for Friday Health Plans members.  This has resulted in payment delays from Friday Health Plans to network providers.  Affected providers should see resumed payments starting next week.  If you have questions about claims with Friday Health Plans, please email providers@fridayhealthplans.com and a Friday staff member will call or email back within 24-48 hours.
December 27: Transition to Link Provider Portal

To support membership growth, better serve our current members and partners, and fulfill our mission of making a genuine difference in the health and well-being of the people and communities we serve, Hometown Health will be going live with Link on Jan. 1, 2022.

With the implementation, there are a few important things to call out as we transition systems.

First and foremost, we are asking for your assistance to make sure members get the care and customer service they need. Please do not turn patients away. Members may contact you with concerning medical care, labs, imaging or prescription medications. Please take all reasonable steps outlined to assist our members before contacting the Customer Engagement Center.

  1. Members are receiving new ID cards with their insurance information. However, members may not receive these cards prior to Jan. 1, 2022.
    1. Please do not send patients away who do not have a card to present. A letter was sent to members containing their new member ID numbers, and please accept this letter as though it is their card. The member ID numbers from last year are not the same as their new Tapestry member ID number.
    2. If a patient presents without their new physical insurance card, coverage information will be available real time in Link to end users. Please see tip sheets on the homepage in Link for additional details.
    3. Members/Patients will be able to find their ID cards starting Jan. 1, 2022 within MyChart if they have an active MyChart account and Hometown Health insurance.
    4. MyChart Push notifications will be sent to patients with Hometown Health insurance outlining how to find their ID card and members info in MyChart.
  2. The HealthConnect portal is currently used to obtain prior authorizations. Beginning Jan. 1, 2022, authorizations will be requested via Link. To sign up for Link, please visit hth.dev.healthyusa.org/link.

We greatly appreciate your support as we work through this transition period. If you have any questions, please reach out to Hometown Health Customer Service at 775-982-3232.

Download these tips for your office here.

Register for Our New Provider Portal
Effective January 1, 2022 Hometown Health will be utilizing Link, a new secure web portal that will provide our provider partners access to referrals, claims, and enrollment information. HealthConnect will no longer be available after 12/31/2021.
Link will be our new provider portal for providers and their office staff. Hometown Health contracted providers and their staff will use Link to communicate, review insurance information, track claims, and manage referrals for patients.
Link will be available beginning January 1, 2022. If you don’t already have an account with EpicCare Link, Site Administrators can register now to be ready for this exciting transition. Once the site is active on January 1, 2022, Site Administrators will be able to grant access to other employees within their office.
We will be holding training sessions to help you understand and navigate Link easier. To sign up for training or find more information on Link, please visit our LINK page on our website.  We look forward to supporting you through this exciting transition.
Effective 1/1/2022 Ambetter will no longer be using the Hometown Health Network.
Currently, Ambetter leases the Ambetter Commercial Exchange network through Hometown Health in Nevada for all counties with the exception of Clark and Nye. Ambetter has made the decision that, effective 1/1/2022, they will contract directly with providers and will no longer be contracted with Hometown Health.  If you have any questions, please contact the Provider Relations team at
NVSS_ProviderRelations@SilverSummitHealthPlan.com and a representative will outreach to you.
Effective July 1, the Nevada Department of Corrections will be using Hometown Health’s Statewide Network.

Medical Claims for health care services provided to inmates of the Nevada Department of Corrections (NDOC) may be submitted in two different ways:

1. Inpatient Services – For inpatient stays in medical facilities that last longer than 24 hours, inmates are eligible for Medicaid. This includes observation care exceeding 48 hours, claims for those stays should be submitted to Medicaid for reimbursement. Claims will be noted by NDOC as “Medicaid Pending”. If Medicaid denies the claim, NDOC will provide an authorization number for services. Send Medicaid denied claims to:

Nevada Department of Corrections
C/O Hometown Health
PO Box 981703
El Paso, TX 79998-1703
EDI Payer ID: 88023
800-336-0123

2. Outpatient Services – For all outpatient services, send claims to:

Nevada Department of Corrections
C/O Hometown Health
PO Box 981703
El Paso, TX 79998-1703
EDI Payer ID: 88023
800-336-0123

All claims sent to Hometown Health for processing must include: inmate name, inmate ID number, date of birth and NDOC authorization number. NDOC authorization numbers may be obtained from NDOC by calling 775-887-3226 or 775-887-3209. Claims denied for no authorization number: providers need to reach out to NDOC Medical Administration at 775-887-3226 or 775-887-3209 to obtain authorization codes.

 
Wednesday, Jun. 30, 2021: Hometown Health and Carson Tahoe Regional Medical Center, Carson Tahoe Medical Group, and Carson Tahoe Continuing Care Hospital have renewed contracts to continue servicing our members

Over the past few months Hometown Health has been negotiating with Carson Tahoe Hospital and its related entities for a new contract. We are pleased to announce we have successfully negotiated a new contract resulting in Carson Tahoe Regional Medical Center, Carson Tahoe Medical Group, and Carson Tahoe Continuing Care Hospital remaining in-network for Hometown Health.

We are appreciative of the partnership with Carson Tahoe Hospital and its related entities and their collaboration to come to an agreement that enables us to keep health costs affordable for our members and the community.

The following Carson Tahoe Hospital entities will remain in network for Hometown Health and Senior Care Plus members on July, 1 2021:

  • Carson Tahoe Regional Medical Center (Carson Tahoe Hospital)
  • Carson Tahoe Behavioral Health, Inpatient
  • Carson Tahoe Medical Group (Carson Tahoe Health)
    • 1470 Medical Parkway, Suite 256 Carson City, NV 89703
    • 10539 Professional Circle, Suite 200, Reno, NV 89521
    • 2874 N. Carson St. Carson City, NV 89706 (Eagle Medical Center)
    • 775 Fleischmann Way, Carson City, NV 89703
    • 1800 N. Minnesota St. Carson City, NV 89703
    • 412 W. John St. Suite B Carson City, NV 89703
    • 901 Medical Center Dr. Dayton, NV 89403
    • 1460 S Curry St. Carson City, NV 89703
    • 926 Incline Way, Suite 150, Incline Village, NV 89452
    • 973 Mica Dr. Carson City, NV 89705
  • Carson Tahoe Continuing Care Hospital
  • Carson Tahoe Surgery Center
  • Carson Tahoe Pain Institute
  • Carson Tahoe Retail Clinics located in Walmart
  • Carson Tahoe Urgent Care Centers
Friday, May 21, 2021: Important Information Related to Contract with Carson Tahoe Regional Medical Center, Carson Tahoe Medical Group and Carson Tahoe Continuing Care Hospital

In recent negotiations, Carson Tahoe Hospital has demanded an 84% percent price hike on inpatient hospital services that will drive up the cost of health care for the members and customers we serve. In addition, Carson Tahoe is asking for 55% percent price hikes on long-term care, and a 20% percent increase on primary and specialty care.

While negotiations continue, the distance between Carson Tahoe Hospital’s demand and Hometown Health’s offer of continual increases over the next three years appears unsurmountable. As a result, and in order to help minimize disruption in care, we are providing early notice that all Carson Tahoe Hospital services and facilities will be out of network for Hometown Health and Senior Care Plus members effective July 1, 2021.

If an agreement is not reached by Wednesday, June 30, 2021, all services for Carson Tahoe Regional Medical Center, Carson Tahoe Medical Group, and Carson Tahoe Continuing Care Hospital will transition to other in-network providers to help minimize disruption in care and to help keep healthcare costs affordable.

Also on that date, any Hometown Health and Senior Care Plus members currently under the care of Carson Tahoe Medical Group providers will be contacted and offered a selection of an in-network provider. We are committed to the health of our community. While we continue to negotiate in good faith, and hope to come to a mutually beneficial agreement in the next 30 days, our top priority is ensuring members have immediate access to care they need. We will continue to keep you informed as negotiations continue.

Read the Termination Notification Letter here.

Monday, Apr. 19, 2021: PPO Network Termination for Public Employees’ Benefit Program (PEBP)

The Public Employees’ Benefits Program’s (PEBP’s) PPO network contract with SHO and Hometown Health (HTH) will terminate effective June 30, 2021. On July 1, 2021, PEBP will transition to the Aetna Signature Administrators (ASA) network. Claims will continue to be handled through HealthSCOPE Benefits.

To ensure PEBP members are not unexpectedly billed for out-of-network coverage, PEBP is requesting all providers who do not participate in the ASA network to inform their PEBP (HealthSCOPE) patients of this change prior to providing any services on or after July 1, 2021.

IMPORTANT: Claims for dates of service prior to July 1, 2021 must be submitted to HealthSCOPE Benefits for processing no later than September 30, 2021. 

For questions, contact HealthSCOPE Benefits at 1-888-763-8232.

View the official termination letter from PEBP and HealthSCOPE.

Wednesday, Mar. 17, 2021: Inpatient Admissions Payments

Please be advised beginning May 1st, 2021 Hometown Health will no longer be responsible for payment of inpatient admissions when timely notification is not received as described in the 2021 Administrative Guidelines. Please review this and other important changes in the updated Administrative Guidelines which are effective May 1st, 2021.

Thursday, Mar. 4, 2021: Open Notes via MyChart

Renown Health will implement Open Notes via MyChart effective Mar. 17 in compliance with the 21st Century Cures Act. Please join one of two provider meetings for more information on how this impacts you and your practice:

  • Monday, Mar. 8 at 12:15 p.m.: (775) 325-5409, Meeting ID 857 438 520#
  • Thursday, Mar. 11 at 5:00 p.m.: (775) 325-5409, Meeting ID 318 892 781#

Please email terri.lightfoot@renown.org for the video link and supporting documents.

Friday, Jan. 8, 2021: Acupuncture for Chronic Low Back Pain
Beginning Jan. 1, 2021 Medicare will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. The benefit information for our Senior Care Plus members is listed in the Evidence of Coverage (EOC) located on the HealthConnect portal. Acupuncture treatment for chronic low back pain will require prior authorization. For additional information, please visit the CMS website.
Please be advised, providers may not collect member cost share from members enrolled in the Qualified Medicare Beneficiary Program, a dual eligible program which exempts individuals from out-of-pocket costs.
Tuesday, Oct. 13, 2020: Friday Health Plans Partnership
Hometown Health would like to announce their partnership with Friday Health Plans effective January 1, 2021. Friday Health Plans will be leasing Hometown Health’s PPO network. This means they will utilize our PPO contracted rates and Hometown Health will be pricing claims based on those rate.
View more information here.
EXPIRED Wednesday, Sep. 30, 2020: SIGNATURE HMO REFERRAL UPDATE
Signature HMO Plan will require a referral and prior-authorization for specialist office visits starting October 1, 2020. Please make sure a referral is in place prior to seeing our member.
Thursday, Jun. 25, 2020: Prior Authorization Update
Monday, Jun. 1, 2020: New COVID-19 FAQs on Medicare Fee-for-Service Billing
CMS released additional Frequently Asked Questions (FAQs) on recent COVID-19-related waivers to help providers, including physicians, hospitals and rural health clinics. Find more answers to questions on:
  • Outpatient therapy
  • Telehealth and appropriate coding
  • Federally qualified health centers
Tuesday, Apr. 14, 2020: Expanded Telehealth Services Update
Hometown Health recognizes CMS has expanded telehealth options and approved payment arrangements for these services. We are following CMS guidelines as it relates to provider payment for telehealth services. Please see the Medicare Telemedicine Health Care Provider Fact Sheet on www.cms.gov for more information. For Commercial and Senior Care Plus members please refer to the members’ plan document in HealthConnect to ensure telehealth is a covered benefit and to confirm member cost sharing. Please see the grid below to determine which of our self-funded groups are covering Telehealth services.
telehealth coverage table
Please note – Hometown Health will contact you if your contract does not currently include telehealth service codes. Otherwise services will be reimbursed based off your current contracted rates.
Friday, Apr. 3, 2020: Signature HMO Plan PCP Referrals Not Required During COVID-19 Emergency

Due to the ongoing COVID-19 state of emergency, members of the Hometown Health Signature HMO plan will not be required to get referrals from Primary Care Providers to receive specialty care.  This COVID-19 policy is effective April 1, 2020 and will expire no later than September 30, 2020, unless otherwise extended by Hometown Health.

The above temporary COVID-19 no-referral policy does not change the requirement to obtain prior authorization from Hometown Health for services as listed in the plan document for any Hometown Health product.  Services related to COVID-19 never require prior authorization for any Hometown Health product.

Friday, Mar. 27, 2020: Prior Authorizations
Hometown Health does not require authorizations for screening, testing and treatment of COVID-19.  While authorizations are required for other services, including when a patient is admitted, a provider should never delay critical treatment because a prior authorization request is pending.  Hometown Health should always be notified when a patient is admitted and when a patient is discharged.
Wednesday, Mar. 18, 2020: Instructions Regarding Cancellations of Elective Procedures
For any cancelled or rescheduled elective procedure that have already been authorized, please do not call Hometown Health. Our preferred method of communication is to fax a list of members, including their name, ID and DOB, as well as the approved authorization number to 775-982-3744. For outpatient elective procedures, we will update the approved authorization to be valid through the end of this year. For any inpatient elective admissions, please fax us the same information, along with the date the procedure has been rescheduled for. We will update approved authorizations as soon as possible and send out updated approval letters.