Plan members

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 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 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.

myHealth Wellness Program Postponed   

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.

Actions to Support Providers During COVID-19 National Emergency

REMINDER: DESIGNATE YOUR PRIMARY CARE PROVIDER

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. 

As you know, Cofinity is migrating to a new claims repricing platform that requires a change in the traditional Cofinity claim submission workflow. The new platform will streamline their administrative processes and help them improve the service they provide to you and payer clients. 

How this impacts you:

Measles can be dangerous for babies and young children.

Symptoms include:

• High fever (can spike to more than 104 F)
• Cough
• Runny Nose
• Red and watery eyes
• Rash breaks out 3-5 days after the symptoms begin

The MMR  (measles- mumps-rubella) vaccine can provide children  protection.

For additional informaiton, please visit these sites: