Latest news

Specialist Co-pays for Lakeland Plan Members has Changed for 2020

January 14, 2020

Lakeland team members and their covered family members have a new co-pay structure for 2020!

PCP co-pays are remaining at $30, but the co-pay for a specialist visit has increased from $30 to $45.

Please make sure your front desk staff is aware of the change. If you are seeing anything different while looking at Real Time Eligibility, please let us know at (269) 927-5207 or (269) 985-4474.

New Employer Group: Lippert Components

January 13, 2020

Effective 1/1/20, Lippert Components is a new employer group who has access to the Lakeland Care Network. This employer group has been added to the LCN Listing of Contracted Payors under the "Employer-Specific Payors" section.  The payor that Lippert has chosen to use is Key Benefit Administrators.  Therefore, all Lakeland Care Network providers are considered participating for all Lippert Components covered members.

LCN Breakfast- Special Topics from UHC and PH

January 7, 2020

Based on the feedback we received at the Payor Conference in October, Lakeland Care Network has planned this special breakfast meeting and invites you to attend so we can bring you information on the new VA Contract with Optum, along with very helpful information directly from Priority Health Claims Department.  This presentation would be helpful for office/practice managers, billing staff, and appeal team members.

Priority Health - Auth Requirements Changes for Commercial Substance Use Disorder Outpatient Services

January 6, 2020

Effective Jan. 1, 2020, substance use disorder intensive outpatient services will no longer require authorization or clinical review for commercial members.

 

Why we’re making this change

We’re removing the authorization requirement to improve members’ access to substance abuse intensive outpatient services to ensure they’re able to get the right care at the right time.

 

How services will be monitored

Info for Offices on 2020 Pharmacy Benefits for SH Lakeland Plan Members

December 20, 2019

In 2019, Spectrum Health Lakeland (SHL) was under their own pharmacy benefit plan with Express Scripts.

In 2020, pharmacy benefiit coverage will still be processed through Express Scripts - but under Priority Health's plan.

See the attached FAQ for more pharmacy benefit information.  Be advised that the formulary has changed from 2019 to 2020.

 

Meridian Monthly Handouts

December 18, 2019

Attached you will find the monthly handouts relating to the following topics:

  • Tobacco Cessation
  • Osteoporosis Management in Women and Preventing Fractures
  • Persistence of Beta-Blocker Treatment After a Heart Attack
  • Appropriate Screening for Prostate Cancer
  • Prescribing Antipsychotic Medications

Please visit the Meridian website for more detailed information.

 

Priority Health - Preventive Guidleline Update: Counseling Services for Pregnant and Postpartum Women

December 11, 2019

Effective Feb. 1, 2020, all commercial group and individual plans will cover counseling services as a preventive service, for pregnant and postpartum women identified as at-risk for depression.

When preventive, counseling services will be covered at 100% ahead of deductible.

Why are we making this change?

2019 Annual Payor Conference Reference Tools

December 11, 2019

Thank you to all who spent the day with us back in October at the Lakeland Care Annual Payor Conferece. We hope it was a valuable day for you and your office. As promised, attached are the presentations for your reference. 

(click on the news article title to see the attachments)

Meridian Adds Training Sessions for New Quality and Safety Program

December 3, 2019

MeridianComplete (Medicare-Medicaid Plan) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective January 1, 2020. This program is designed to work collaboratively with providers in promoting patient safety through the practice of high-quality and cost-effective care for MeridianComplete members undergoing musculoskeletal surgical procedures.

 

Priority Health - Front End Rejection Claims Now on the Provider Protal

November 21, 2019

We heard you, and we're making an exciting change to our online provider portal to help you work with us faster and easier. As part of our commitment to reducing your hold time when you call us and giving you more of the information you need at your fingertips, front-end rejected claims and reasons are now available on our provider portal.

 

Where to find your front-end rejected claims

Priority Health: Substance Use Disorder Auths Changes

November 20, 2019

Effective Jan. 1, 2020, substance use disorder intensive outpatient services will no longer require authorization or clinical review for commercial members.

 

Why we’re making this change

We’re removing the authorization requirement to improve members’ access to substance abuse intensive outpatient services to ensure they’re able to get the right care at the right time.

 

How services will be monitored

Priority Health: 340 B Claims Changes

November 20, 2019

Priority Health is making changes to their 340B program based on your feedback. PH will now review 340B claims post-payment, which means that they will review paid claims quarterly.

 

What can facilities expect?

The first post-payment review will begin in December 2019 for providers enrolled in the 340B program. We may contact facilities for a list of drugs purchased through the 340B program or for specific exclusion criteria.  

 

Does the 340B program apply to Medicaid claims?

Meridian Complete: Launch of New Surgical Quality and Safety Management Program

November 20, 2019

MeridianComplete (Medicare-Medicaid Plan) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective January 1, 2020. This program is designed to work collaboratively with providers in promoting patient safety through the practice of high-quality and cost-effective care for MeridianComplete members undergoing musculoskeletal surgical procedures.

Please see the attachment for details.

Meridian Monthly Handouts

November 13, 2019

Meridian is providing monthly handout on these following topics:

  • Breast Cancer Screening (BCS) and Cervical Cancer Screening (CCS)
  • Adult BMI Assessment and Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Well-Child Exams and Lead Screening (LSC)
  • Timeliness of Prenatal Care (PPC) and Postpartum Care
  • Notice Regarding Authorization for Medicare and Turning Point Implementation

PH - Prior Auth Requirement for Outpatient Behavioral Health Changes

November 12, 2019

Effective Jan. 1, 2020, Medicaid outpatient behavioral health therapy will no longer require prior authorization. You will no longer need to submit clinical documentation for these requests.

Why we’re making this change

We’re removing the authorization requirement to improve members' access to the mental health services they need to ensure they’re able to get the right care at the right time.

Meridian Monthly Informational Handouts

October 30, 2019

Attached are the informational handouts from Meridian for October:

  • Medication Management for People with Asthma (MMA)
  • Comprehensive Diabetes Care (CDC) and Controlling High Blood Pressure (CBP)
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
  • Preventing Readmission: Following up with Discharged Patients
  • Transitions of Care (TRC)
  • eviCore Expansion Prior Authorization Overview Training Sessions
  • Catching a Breath Program Informationa and Referral Form

Cigna - How to Access Patient Reviews

October 11, 2019

All patient reviews will be posted to the Cigna for Health Care Professionals website (CignaforHCP.com). They can only be accessed by the providers for whom they were submitted or their delegated office staff. To view, read, and respond to reviews, providers and their delegated office staff must be registered users of CignaforHCP.com.

Meridian - Medicaid Authorization Lookup Tool Updates

October 2, 2019

Noted in the September Monthly Provider Notification, the Meridian Medicaid Authorization lookup tool for MI and IL has been updated.

As previously discussed, the following improvements have been made to the tool:

-          Additional Blanket Statements added

-          Both excel and PDF versions posted to our website

-          Accessibility on the website was updated to provide easy access to the tool. Providers now can access directly from the home page through the provider tool “Prior Auth Form and Requirements”.

Meridian and eviCore - Prior Authorization Training Sessions

October 2, 2019

eviCore healthcare and Meridian are expanding their partnership to include the following programs: physical therapy (PT), occupational therapy (OT), genetic testing, pain management, and sleep studies. eviCore will be leading orientation sessions designed to assist you and your staff with the new programs. You will be able to attend the web orientation session that works best for you and your schedule.

LMOA - October LCN Annual Payor Conference

September 30, 2019

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 Monthly Information Handouts

September 26, 2019

Attached are the informational handouts from Meridian for September:

  • Low Back Pain and the Use of imaging Studies/ Acute Bronchitis and the Use of Antibiotics
  • Pneumococcal Vaccination
  • Influenza Vaccination
  • American Sign Language Translation Service

 

Whirlpool Updates ID Cards Effective 10/1/19

September 23, 2019

HealthSCOPE Benefits (HSB) is the Benefits Administrator for Whirlpool Corporation medical plan participants.  We wanted to make sure you and your billing teams were aware that effective October 1, 2019, the PPO provider network for the Whirlpool Corporate members will change to the United Healthcare Choice Plus Network.   In addition, Whirlpool plan members will continue to have in-network access to all of the Lakeland Care Network providers as they have had in the past. 

Cofinity Claims Submission Process Update - September 2019

September 19, 2019

US Health & Life is the only remaining LCN contracted payor who is a part of our Cofinity contract  that remains to switch for claims address changes.  Their change date is set for 10/1/19.

Important:  Some Payer EDI #’s were updated since the last version, please look for the Payers with an asterisk next to their name as those EDI#’s will need updated for accurate routing!

UHC-CP New Member ID Cards

September 19, 2019

UHC-CP has issued some new member ID cards.  Please see the attachment for sample cards for the following product lines:

  • MA or Medicaid
  • HMP or Healthy Michigan Plan
  • DSNP or Dual SNP Plan

eviCore and Meridian Health - Expansion of Prior Authorization Webinars

September 10, 2019

eviCore Healthcare and Meridian are expanding their partnership to include the following programs: physical therapy (PT), occupational therapy (OT), genetic testing, pain management, and sleep studies. eviCore will be leading orientation sessions designed to assist you and your staff with the new programs. You will be able to attend the web orientation session that works best for you and your schedule

Meridian Health - 2019 Model of Care Training

September 10, 2019

Meridian Health is asking providers to complete their Annual Model of Care (MOC) training for ALL providers who care for their plan members.

You can find this training module at their website: www.mymeridiancare.com for additional instructions; also, please see attachment for full instructions and details on this training from Meridian Health.

Note: One person in the office can take this training, and then train the rest of the office.

 

Please call Meridian Health for any questions at 1-877-902-6784.