Providers

August is National Immunization Awareness Month

A friendly reminder from UHC:

Attached is a brief summary of UHC's electronic data education  which includes information and resources for electronic transactions.

Here is this month's educational handouts from Meridian:

• Healthy Michigan Plan - Health Risk Assessment
• Meridian Health Healthy Michigan Plan Informational Handout
• MeridianCare (Medicare) Brand Transition information

Aetna Better Health  has recently provided the following informaiton:

Please review the information below regarding EVICORE authorizations and appeal guidelines.

Medical Prior Authorizations:   

Note:  If a claim denies not authorized, providers must request an authorization before submitting a provider appeal.  If the retro authorization request is denied, a provider appeal can be submitted to the health plan.

High Tech Radiology Authorizations

Attached is an example of the Priority Health insurance card for the Bronson Narrow Network to use as a reference.

Below is a link to the Priority Health website where there are examples of all of Priority Health cards for all of their products. 

Aetna Better Health of Michigan will be updating on or before August 1, 2019 their Provider Manual and Website to provide clearer understanding and instruction to providers related to the various Dispute / Appeal / Grievance processes that are available. These updates apply to BOTH our MI HealthLink Duals product & our Medicaid product. 

Please see attached flyer for more detailed information.

Aetna Better Health of Michigan occasionally updates codes to change prior authorization (PA) requirements.  Effective September 1, 2019, Aetna Better Health of Michigan, for all lines of business, will not require prior authorization for some CPT/HCPCS codes before services are rendered.  Please note the allowable units for each service below.

For the complete list and details, see the attachement.

Meridian has provided these informational handouts for refernece:

• Potentially Harmful Drug Disease Interactions in the Elderly
• MeridianRx.com instructions
• Notifications of Enhanced Claim Review Processes regarding clinical chart/DRG reviews
• Use of "Request for Claim Dispute" form for better routing of disputes

Summary of the Incident:

Attached is an updated version of the ASR provider manual that has been updated, and will be effective as of July 1, 2019.

Key components of these changes address: