Providers

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:

UHC - Extends Temporary Prior Authorizations Suspensions for COVID-19, Vaccine InformationTraining and New Back Pain Program

January 11, 2021

UnitedHealthcare is extending the temporary suspension of select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide through Jan. 31, 2021. The temporary suspensions are effective from Dec. 18, 2020 through Jan. 31, 2021. (They were previously set to end on Jan. 8, 2021.)

HUMANA - Cohere New Authorization Process and Training for 2021

January 5, 2021

Humana has provided us the attached Power Point presentation regarding their NEW authorization process -- Cohere.  This process began on 1/1/2021.

Please read the details in this attachment about how to submit a request, the clnical review process, peer to peer consults, and many more details regarding this new authorization system.

 

Priority Health - Physician and Practice News Digest - Winter 2020 and PIP Manual

January 4, 2021

Please read the attachment for the latest news from Priority Health!

 

In addition from Priority Health:

The 2021 PCP Incentive Program (PIP) manual is finalized and available for download. Visit 2021 PCP Incentive Program Manual (priorityhealth.com) to view.

 

Overview of 2021 finalized PIP manual

2021 new measures

UHC- January 2021 NEWS

January 4, 2021

Please read the informational attachments for the latest from United Healthcare on COVID-19, Tele-health, The Administrative  Guide for 2021, and much more  in 2021.

 

Also, please connect with this link to sign up for future emails from UHC:  Please visit: UHCprovider.com/subscribe to sign up!

 

CIGNA- COVID-19 Vaccine, Treatments, and Extended Coverage

December 28, 2020

Since the COVID-19 pandemic began, CIGNA has delivered timely accommodations to providers and customers, and ensured that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.

Please read the attachment for details on vaccines, treatments and extended coverage accommodations.