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1/Here we go again--in the midst of the #COVID19 when @EmergencyDocs are in harms way for all of us, #healthplans @Amerigroup in this case can't help themselves from using illegal diagnosis lists/algos/bots that key off final diagnoses--expressly not allowed by @CMSGov ...
2/ 2 flag both #outofnetwork & in-network claims (is the delay on the latter a cynical attempt 2 force contracting?)--4 chart review to determine #prudentlayperson status or not--if deemed "non-emergent" then a triage fee is paid--& if no records or so they claim then triage fee
3/ BTW--just received the "auto pay" list--it states its effective 5/1/20--& is 64 pages; there are many thousands of #ICD10 codes--& what a surprise that this plan is an @AnthemInc company--the acorn does not fall far from the oak tree--one of the pioneers of illegal diag. lists
4/ Top page of the "auto-pay lists"--takes a special kind of health plan to implement these measures at a time like we're in now--been down this road so many times before & will step into the breach again...
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