UHC - June 2023 Monthly Updates
United Healthcare has shared their June’s Network News updates for June 2023
The issue with Medicaid edit 5167 incorrectly front-end rejecting claims, first discovered on May 23, was resolved on May 30. All impacted claims have been reprocessed
Original Noted posted May 26, 2023:
The attached 2023 issue of BCN Partners in Care has been mailed to all contracted Blue Care Network providers, one copy per address.
Below is a news release from Priority Health:
On Jan. 1, 2023, CMS released two new care management codes for chronic pain management – G3002 and G3003 – which allow providers helping chronic pain patients to bundle key services and bill monthly rather than a’ la carte.
Priority Health is experiencing an issue with their Medicaid claims front-end rejecting for “Claim Type Requires a Referring/Ordering NPI” when they shouldn’t. Priority Health teams are working to find the root cause and fi
Priority Health has provided an update:
Health care professionals who are contracted with UnitedHealthcare are required to verify demographic data every 90 days.
Blue Cross Blue Shield of Michigan and Blue Care Network have implemented a monthly data feed to inform you of your group’s assigned BCN AdvantageSM members who are eligible for the Landmark Health high-intensity in-home care program for members with multiple chronic conditions.
From Humana: In a continued effort to optimize care for our members and ensure prompt delivery of quality DME, Humana has entered into enhanced partnerships with DME provider— Rotech. Effective July 1, 2023, Rotech will manage Humana’s Medicare Advantage (MA) health maintenance organization (HMO) business.
Humana has posted it's most recent newlsetter for physicians.
The Q 2 2023 Newsletter: This newsletter is for physicians, specialists, clinicians and office staff to deliver the latest news, resources and administrative information to support them in the care of their patients. (note hyperlinks)
On June 1, 2023, the state of Michigan will restart full eligibility reviews for D-SNP, Healthy Michigan and Medicaid members.
What is Medicaid redetermination?
Medicaid redetermination is the process by which Medicaid members must reapply for their Medicaid benefits and prove they qualify for Medicaid.
Aetna Better Health is excited to announce that we’re moving to Phase 2 of the Availity Appeals Enhancement Pilot. What we need are Providers (office staff), that are willing to participate in the Pilot. The above attachment gives a high level overview of what the Enhancement is about.
Lakeland Care Network (LCN) was recently informed by Humana that certain taxonomy codes are no longer accepted by their Medicare product as of 10/31/2022.
What is Medicaid Redetermination?
Medicaid redetermination is the process that states use to ensure that Medicaid enrollees continue to be eligible for Medicaid coverage. Typically, redetermination happens once a year; however, the rules changed during the pandemic. During the COVID-19 public health emergency, the federal government paused Medicaid redetermination. Renewals were not required during this time, and enrollees could not lose their health coverage.
We want to make sure you stay informed about your patients and practices who are offered the opportunity to receive a free pharmacogenomics test as part of BCN’s new Blue Cross Personalized MedicineSM program.
Below is the full list of contact information for Valenz Health:
A new employer group, AZO Services, now has access to the Lakeland Care Network through our Confinity contract. Effective May 1, 2023, AZO Services will be using the payor Auxiant. This payor will now have 3 employer groups using them: South Shore Enterprises, Getman Associates, and now AZO Services. Auxiant is one of Lakeland Care Network's 'employer-specific payors. Keep in mind that all Lakeland Care credentialed providers will be considered in network for Auxiant, but ONLY for the three employer groups listed above.
Attached you will find the monthly updates for April 2023 from our partners at United Healthcare.
Humana has made siginificant changes to their commerical products in regards to preauthorization and notifications in 2023
Please visit this link for all Humana updates:
As you may know, in April 2022, Governor Whitmer signed the prior authorization reform bill, Public Act 60 (PA 60), into law. We’re excited that this legislation supports streamlining how we work with each other, making it easier for our members – your patients – to get the care they need when they need it.
On May 28, we’ll implement the new clinical edits listed below and outlined in detail in the following documents:
As Michigan’s Prior Authorization Reform legislation (SB 247 / PA 60) goes into effect on June 1, 2023, we’ll implement new requirements for some of our prior authorizations to help ensure timely, appropriate care for our members, your patients.
Starting June 1, in accordance with PA 60, we’ll decrease our prior authorization turnaround time from 15 days to 9 days for our commercial, individual / ACA and governmental self-funded plans.
On Apr. 1, 2023, our payment reference IDs that accompany claim and capitation payments will change.
The date-related characters in the payment reference ID will change from an 8-character pay date (YYYYMMDD) to a 5 character pay date that uses Julian date logic (YY Julian date).
This update applies to both our commercial and Medicare members.
Effective March 1, 2023, we will no longer require precertification for the site of service for vitrectomy procedures.
The following new-to-market drugs require precertification....
We have received multiple questions regarding the impact the Blue Cross Personalized MedicineSM program has on your annual Product Exhibits.
Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You are invited to attend a Veterans Affairs Community Care Network Overview educational session.
Now that claim reconsiderations and appeals must be submitted electronically,* we want to help make sure you have the how-to information you need to manage them with ease.
You have 2 electronic submission options — through the UnitedHealthcare Provider Portal or Application Programming Interface (API). See the Online Reconsiderations and Appeals interactive guide for step-by-step instructions on how to submit reconsiderations and appeals electronically.
Attached is the 2023 Calendar for the Lakeland Pediatric Sub Specialty Clinic located in the Health Park Medical Suites in St. Joseph. The providers who round to this clinic are all from Helen DeVos Children' Hospital in Grand Rapids. The purspose of this clinic is to provide specialty pediatric care right here in Berrien County so parents don't have to take the time to drive their child to and from the hospital in Grand Rapids to see their child's specialist.
A big thank you to Brian, Rachel and Amanda from Lakeland/Corwell Health South's Compliance team for their presentation to the LMOA membership on Wednesday, March 15, 2023. As promised, below is their presentation for your reference.
From Humana, there are more informational handlouts provided for your use, including the Humana Quarter 1 Physician News and Real Tme Benefit Check.
Please read about Humana's new CenterWell Pharmacy and Prescription program; flyers are attached below for your reference.
From Humana, there are a number of informational handouts and flyers on their program updates. Please read the attachments for all that may apply to your offices.
Dear BCN-Affiliated Medical Care Group Business Administrator:
We recently fixed an error with a clinical edit impacting the following services:
From United Healthcare, please read the provided attachement for the latest updates as of March 2023.
We’ve partnered with Livongo to offer a digital diabetes management program to your commercial fully funded patients with type 2 diabetes. This program will strengthen the care you provide and offer the extra support your patients need to manage their health.
We’re reissuing new ID cards to our commercial members to update the pharmacy processing information on the back of their card. This change will take effect April 1. Members will receive their new cards between March 31 and April 28.
Dear BCN-Affiliated Medical Care Group Business Administrator: