Now that Lakeland employees have moved from ASR to Priority Health, here's some helpful information for your office to know for your patients who are Lakeland plan members. The attached update reviews correct copay amounts for Primary and Specialty Care, Patient Costs, Covered Preventative Services, Referrals and Prior Authorizations.
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 improve the service they provide to you and their payer clients.
How this impacts you
The Lakeland Care Network has added two additional Employer-Specific payors to our panel.
Effective February 1, 2019, all Lakeland Care Network providers and offices participate with Prairie States Enterprises through our Cofinity contract. You are participating with this payor ONLY for the HighGrade Materials employer group.
The Lakeland Medical Office Association invites you to attend our March luncheon and seminar. This month’s seminar is two presentations in one and will include role-playing scenarios for clarity at the end.
Dr. Birris will be speaking first on how medical stressors affect how patients react to medical staff. Then, Norma Tirado will be talking about how we react to those stressed patients and why - what triggers our bad reactions.
Meridian has provided some informational handouts on the following topics:
Lakeland Care Network Employer Services is offering you a chance to hear more about how to navigate the new law while maintaining a safe work environment at our upcoming breakfast forum. Hurry, registration ends Friday, February 15, 2019.
Will Marijuana Legalization Change Workplace Drug Policies?
Does the New Law Require Employers to Allow Use at Work?
What Does it Mean for Testing?
The Lakeland Medical Office Association invites you to attend our February luncheon and seminar.
Program: ICD 10 and Coding Updates
Please remember that all labs requested for Lakeland associates, need to go to Lakeland laboratories, not Quest.
Although the plan administrator changed from ASR to Priority Health for the Lakeland employees on 1/1/19, the requirment for Lakeland covered plan members' labs stays the same - they must be sent to Lakeland for in-network consideration.
As Southwest Michigan Behavioral Health (SWMBH) continues to move forward in reducing paper and finding more efficient and cost effective ways to reduce healthcare administrative costs we are making changes to allowable claims submission methods for providers.
Effective October 1, 2018, SWMBH will no longer accept paper claims from its provider network. Claims will be returned to the provider. There are now multiple ways for providers to submit claims to SWMBH without the need for paper forms. Claims may be submitted in any of the following ways:
The Lakeland Care Network has added an additional Medicare contract to its panel. Effective 1/1/19, all Lakeland Care Network providers and offices participate with Blue Care Network's Medicare Advantage HMO plan. This new contract will join Lakeland Care's two other existing Medicare Advantage contracts that are held with Humana and Priority Health. As this is a new contract, membership numbers will be low, so you may not see very many patients come in with this new coverage this year.
With the change from using ASR as their medical benefit plan administrator to Priority Health, Spectrum Health Lakeland wishes to provide some clarity on their associates' co-pays for 2019.
The co-pays for Lakeland associates remains $30 for PCP and Specialty visits.
Effective on January 1, 2019, Gaishin Manufacturing and Supreme Casting have changed their insurance coverage from Ameraplan to ClaimChoice.
At this time, please continue to send claims to Cofinity until further notice of changes.
LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.
The Lakeland Medical Office Association invites you to attend our January luncheon and seminar.
Program: Legislative Update of Current Political Events and their Effect on Medical Practices
Join us for Josh Richmond’s presentation on Michigan’s current political events and policy.
Topics will include:
Meridian has provided informational handouts on the following topics:
Please read the attachements for details.
Over the last several years, the need for mental health services in our nation as well as our own communities has steadily increased. Based upon the results of Lakeland’s Community Needs Assessment, we have learned that in order to meet the mental health demands of the community, we must expand our network.
Specific to mental health providers, Lakeland Care has credentialed physician psychiatrists and LP’s (Licensed Psychologists) which include the doctoral level degrees of PhD, PsyD, and EdD.
LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.
The Lakeland Medical Office Association invites you to attend our November luncheon and seminar.
Program: Safety in Physician Offices
Nearly half of all non-fatal injuries that occur at work, take place in either Health Care or Social Services settings.
Attached you will find the latest information regarding the Southwest Michigan Pediatric Subspecialty Center. These clinics run on a rotating basis at our Health Park Medical Suites, 3950 Hollywood Road, St. Joseph, MI.
Listed are the dates and contact phone numbers for each of the specific pediatric clinics.
Please see the attached notification of upcoming ASR changes impacting the areas of:
The updated version of these requirements will also be included in a revision to the Provider Administrative Manual, which is available online through the ASR Provider Portal.
Also attached, is a revised “At-A-Glance” page, reflecting these changes.
A repeat of a previous article.
For MeridianChoice, commercial product found on the exchange, attached you will find the Prior Authorization list for services.
On September 28, 2018, Cigna changed how providers will register for, and obtain the appropriate level of access to, the Cigna for Health Care Professionals website (CignaforHCP.com).* Now, newly assigned website access managers at each practice will manage these functions.
Thanks to all who spent the afternoon with us this week at the annual Lakeland Care Network Payor Conference. We hope it was a valuable day for you and your office or department. Attached are presentations for your reference. The link to ASR's summary is here.
August 29, 2018: Health care providers that serve Medicaid beneficiaries are facing an upcoming enrollment deadline that is necessary for them to continue to receive payments from Medicaid.
While the Michigan Department of Health and Human Services (MDHHS) has revised the timeline to give providers more time to enroll, the department is urging providers to complete the screening and enrollment process as soon as possible.
The Centers for Disease Control and Prevention (CDC) recommends that patients 6 months and older receive an annual flu vaccine.
This year’s seasonal flu vaccine will cover the three most common strains in the Northern Hemisphere, as identified by the CDC:
• A/Michigan/45/2015 (H1N1)pdm09-like virus
• A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
• B/Colorado/06/2017-like (B/Victoria/2/87 lineage) virus
Please read the attachment for additional information.
Take action today to avoid interruption to your work
ABH has provided new informational handouts on the following topics:
In an effort to respond to network provider feedback with respect to the scheduling process of peer-to-peer reviews, there is a new effort underway at UHC to improve the provider experience with our Peer-to-Peer review process.
The Lakeland Medical Office Association invites you to attend our October luncheon and half-day meeting, sponsored by the Lakeland Care Network.
Program: Lakeland Care Network’s Annual Payor Conference
This year’s Payor Conference will feature the major payors in our market – including those who have Commercial, Medicare, Medicaid and dual eligible products. Lakeland Care will also provide an update on our network's current projects and future initiatives.
Meridian has provided some informational handouts on the following topics:
Starting October 1, 2018, UHC-CP is changing their Obstetrical Ultrasound Policy to further align with Medicaid guidelines. Medicaid doesn’t consider ultrasounds to be medically necessary if they’re done only to determine the fetal sex or provide parents with a photograph of the fetus. A detailed ultrasound fetal anatomic examination is also considered medically unnecessary for a routine screening of a normal pregnancy.
What’s Changing
UHC-CP willl implement these guidelines for claims processed on or after October 1, 2018:
Meridian has provided some informational handouts on the following topics:
LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.
Katie Rogers, our SW Michigan Provider Relcations Consultant for Blue Cross, has informed us that beginning 10/1/18, Blue Care Network (BCN) will utilize AIM for cardiology and high-tech radiology prior authorizations. If your office or department requests prior authorizations, please take advantage of several webinars that BCN has created for you.
The Affirmant's Third Annual Leadership Retreat was recenlty held.
Attached is a newsletter highlighting the events.
Priority Health is making changes to their eviCore prior authorization program based upon your feedback to better serve you while ensuring our members are getting high quality, cost effective care.
Starting on Sept. 5, a subset of the high-tech radiology CPT codes will stop auto approving and will require authorization.
This means:
Some requests may pend for additional information. Once the information is received a decision will be made within two (2) business days.
On Oct. 3, 2018, the Humana.com secure medical provider portal will close. Use the Availity Provider Portal instead to work with us online.
Take action today to avoid interruption to your work
The most up-to-date tools for working with Humana online are already available on the Availity Provider Portal. Please make the switch to Availity now to ensure continued access to Humana’s secure online tools.
In October 2018, Humana will be permanently closing their secure portal on Humana.com and migrating to Availity.com.
Attached you will find an Availity Webinar Schedule if anyone in your office needs assistance, as well as an informative PDF about the upcoming switch.
Meridian has provided informational handouts on the following topics:
New Medicare Card: MBI Look-up Tool Available through your MAC
Attached you will find a listing of all services that require pre authorization for your Patients with Meridian Choice coverage. A PCP visit does not require a prior authorization. Meridian Choice is a option offerered on the Health Insurance Exchange. LCN does PAR with this this plan.
