Providers

Attached are two handouts supplied from Meridian for May 2020:

• Children's Behavioral Health Measures
• Adult Behavioral Health Measures

Frequently asked questions to support physicians working with Humana

To support providers with caring for their Humana patients while promoting both patient and provider safety, we expanded the scope, reimbursement rules and channels for telehealth services. We have received many questions and have provided answers to the most frequently asked questions. This FAQ will be updated as we reevaluate our telehealth policy in light of the COVID-19 public health emergency.

Please read the attchemnt for all of the details!

Priority Health has NEW Claims tool which now supports Microsoft Word and Excel file attachments for appeal and medical record submissions

The Claims tool within the Provider Portal now supports Microsoft Word (.doc and .docx) and Excel (.xls and .xlsx) file attachments for appeal and medical record submissions. This is in addition to file types already supported, which include: csv, .pdf, .png., jpg, .jpeg and .txt.

From Humana:  

Administrative Update for Providers announcing that Humana will resume medical record requests for claims reviews, effective May 15, 2020.

Distribution of this letter is as follows:

Beginning the week of May 18, 2020, we’ll be reaching out to Medicaid members, or guardians, who are due for immunizations, asking them to schedule these appointments with their primary care providers (PCPs).

We’re also resuming sending reminders for well-child visits. These reminders are sent quarterly via letter or email and ask members, or guardians, to schedule the appointment with their PCP.

Immunization campaign

We’ll be reaching out to two groups of members with phone calls from our customer service team:

From United Healthcare Community Plan:

In honor of Risk Management Week, Michigan Professional Insurance Exchange is extending this special invitation to you to join us for three separate webinars, June 16-18 for the 2020 Regional Education and Networking Meeting. Don’t miss this excellent opportunity to gain strategies to mitigate risks and improve patient safety while virtually networking with other risk management, executive, clinical and patient safety leaders. Registration for each webinar is highlighted below.

United Healthcare has provided these monthly informational handouts:

• Link and EDI Training
• Logisticare Monthly Letter
• Covered Services related to the Coronavirus Disease 2019 (COVID-19)
• Medicaid Q2  Common Formulary Updates
• UHC-CP  Fax Number Change for PCP Change Request Form
• May 2020 Network Bulletin
• Unitied Healthcare 2020 Community Care Michigan - Care Provider Administrative Guide and  Provider Manual
• United Healthcare Dual Complete Care Management Program

All of us at Humana are inspired by your commitment and sacrifice in caring for your patients in the communities we serve together. We deeply appreciate all you have done to stay connected with your patients, and the creative approaches you have developed to care for our members during this crisis. Some members have used telehealth as a means to stay connected with their care providers while others may have delayed care while at home, which could adversely impact their health.

We know how important it is to have the Priority Health members you see assigned to your practice. That’s why we’re making changes based on your feedback to improve our member assignment.

We’ve started with our individual product reviewing our members’ assignment against claims data. Effective May 1, we’ve updated HMO and POS members’ assignments when they’re seeing a PCP different than the one chosen at enrollment. Members seeing a provider at the same office or accountable care organization (ACN) assignments will not change.