Plan members

Priority Health - NEW Telehealth PCP Plan for 2021

The Telehealth PCP is a new plan that just launched in 2021 for Individual members. The plan offers virtual-first primary care coverage through our partner, Doctor on Demand®. However, by choosing this plan, members are assigned a PCP from Doctor on Demand. Any in-person care needed is referred back to the Priority Health HMO network.

Individuals can choose their own plan during open enrollment either through the marketplace, their agent or Priority Health directly.

AETNA Medicare is Changing Member IDs

February 25, 2021

Aetna  Medicare member IDs are changing from the alpha numeric mix of MEB or MED**** to 12 digit numbers starting with ‘10’.  See below on the info/details and ID card examples

Member ID numbers are changing

  • Member ID numbers are 12 digits and start with ‘10’
  • Members will be mailed new ID cards

If a claim for a 2021 date of service is submitted using an older 2020 HMO member ID, claims logic is in place to evaluate the member ID and the DOS and redirect the claim to the appropriate claims platform.

Priority Health - Scam Alert: Fraudulent Prescription and Certificates of Medical Necessity (CMN) Requests

Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.

What you need to know

Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.

 

Examples of fraudulent requests:

CIGNA - 2021 Partnership with Priority Health

December 2, 2020

Cigna has entered into a new Strategic Alliance with Priority Health. This partnership enables us to leverage the best capabilities of both organizations, and deliver a health care experience in Michigan’s Lower Peninsula that is more predictable and simplified for providers and customers.

Cigna members will begin accessing medical care through the Priority Health network effective 1/1/2021

Humana - Breast Cancer Screening and Eye Exam Campaign

September 8, 2020

Humana on September 2, 2020 will launch a new program.campaign.

Members with  Medicare Advantage who have not had  breast cancer screening or a comprehensive eye exam will be encouraged to schedule their mammogram and/or comprehensive eye exam in consultation with their doctor to keep their health and safety top of mind during the pandemic.

Eligible Members will be receiving an email or leter from Humana duirng the campaign period of September 2, 2020 through November 2020.

Priority Health - New Medicare Advantage Hospital Admissions Provider and Patient Eduction

June 24, 2020

When it comes to hospital visits, we at Priority Health know coverage and costs can be confusing for our Medicare Advantage members. That’s why we’ve developed two education pieces about Medicare Advantage hospital benefits and costs—one for you and one for your patients—that explains how these benefits work in 2020.

Whirlpool Updates ID Cards Effective 10/1/19

September 23, 2019

HealthSCOPE Benefits (HSB) is the Benefits Administrator for Whirlpool Corporation medical plan participants.  We wanted to make sure you and your billing teams were aware that effective October 1, 2019, the PPO provider network for the Whirlpool Corporate members will change to the United Healthcare Choice Plus Network.   In addition, Whirlpool plan members will continue to have in-network access to all of the Lakeland Care Network providers as they have had in the past.