Providers

UHC - Self Service Resources

August 1, 2019

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

 

Meridian - Monthly Informational Handouts

July 24, 2019

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 Premier - EVICORE Authorization and Appeal Guidelines

July 22, 2019

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

ABH - Update on Dispute/Appeal/Grievance Processes

July 2, 2019

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.

ABH - Prior Authorization Codes 2019 Updates

July 1, 2019

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 - Monthly Informational Handouts

June 27, 2019

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