Cigna has entered into a new Strategic Alliance with Priority Health. This partnership enables us to leverage the best capabilities of both organizations, and deliver a health care experience in Michigan’s Lower Peninsula that is more predictable and simplified for providers and customers.
Cigna members will begin accessing medical care through the Priority Health network effective 1/1/2021
Please see the attached United Healthcare Network Bulletin regarding 2021 updates and changes to programs and policies.. Additionaly, please read the monthly handouts and bulletin..
As partners with you in your patient’s health, we want to keep you informed of the various member programs happening now through the end of the year, with the goal to help keep Medicare and Medicaid members, your patients, safe and healthy with more resources and support in addition to their doctor visits.
Like you, we are concerned with the unprecedented surge of COVID-19 cases in Michigan. We strive to understand the unique challenges different states face and determine how we can help.
In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial members for the entire state of Michigan through Dec. 31, 2020. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.
Attached are the Meridian Provider educational handouts for the month of November 2020.
We’re excited to share 2021 product updates for our Commercial and Medicare products. The information below provides an at-a-glance view of changes. For more detailed product information, reference the attachments included with this email or view a recording of our Oct. 15 Virtual Office Advisory webinar, focused on product updates.
Commercial formulary updates effective Jan. 1, 2021
In January and July of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs.
In 2020, we’ve made more than 66 enhancements, including 46 new drugs and changing 20 current drugs.
To help practices who are busier than normal in 2020 we’ll use our existing data sources to collect Medicaid PCMH incentive information.
As a reminder, the 2020 Medicaid PCMH incentive has 3 requirements:
There’s nothing you need to do. We’ll gather this information from the following sources:
Attached are the Meridian Provider educational handouts for the month of October 2020.
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Cigna launches five-year initiative to combat systemic racism
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Cigna launches five-year initiative to combat systemic racism
The attached Provider Bulletin No 179 was sent to the Medical Practice Group via fax blast today. ABH has asked us to inform practice managers within our network.
Provider Bulletin No 179 November Webinar! Coding Specific Topic: Closing HEDIS gaps for HEDIS 2021
Webinars date/time:
November 10 – 11:00 AM EST
November 11 – 2 PM EST
TOPICS:
Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.
Below is the UHC November Network Bulletin Summary. Please review and share with staff as needed. The entire bulletin can be found at www.UHCprovider.com > Network Bulletin.
Please read the attachement below fo rspecific details.
Please read the attachment regaarding news from Priority Health on a number of important requrements and changes.
Included in this newsletter are:
See the attachment for detils please.
From UHC:
Radiology notification regarding CPT codes being added to the Radiology Notification and Prior Authorization list. This will go into effect for claims with dates of service on or after Jan. 1, 2021.
There’s no question. It’s a different health care environment today. But with Cigna’s new virtual care reimbursement policy for commercial medical services, there’s one thing that doesn’t need to change: the connection you have with your patients with Cigna coverage – even if they can’t come into your office, and even beyond COVID‑19.
Fellow physicians and healthcare professionals:
The last several months have been unlike any other in our lifetime as we are navigating this pandemic together. However, I believe we will emerge on the other side in a stronger, better state. As we continue along this new normal together, I want to share two updates with you regarding reactivating standard authorization processes and new programs for your Humana patients to support the care they receive from you.
Reinstating Authorizations for COVID-19 Diagnoses
Please visit UHCprovider.com for the full news brief.
There is informaiton on a New prior Authorization and Notification tool, information on the expansion of the Dual Special Needs program, and many more important updates
Providers logged into a provider portal account can see health conditions and lab values and prioritize patient visits based on gaps in care using the Patient Profile tool.
With the Patient Profile tool you can:
Below is a summary of the October 2020 Network Bulletin. The entire member can be found at www.UHCprovider.com > Network Bulletin. in addition, there is 2020 Flu Shot informaiton also attached. Please review and share with staff.
Aetna Better Health has sent their September 2020 monthly handouts. Please see the attachments:
Attached is the latest FDR newsletter; please read for the latest AETNA information.
Introducing Evernorth
Attached are the Meridian Provider educational handouts for the month of September 2020.
UnitedHealthcare is updating a number of temporary provisions that were established as part of the COVID-19 response. Here’s a high-level summary of the changes:
Locating patient benefit information should be quick and easy. Providers logged into a provider portal account can see eligibility, benefits and deductible balances using the Member Inquiry tool.
With the Member Inquiry tool you can:
Humana on September 2, 2020 will launch a new program.campaign.
Members with Medicare Advantage who have not had breast cancer screening or a comprehensive eye exam will be encouraged to schedule their mammogram and/or comprehensive eye exam in consultation with their doctor to keep their health and safety top of mind during the pandemic.
Eligible Members will be receiving an email or leter from Humana duirng the campaign period of September 2, 2020 through November 2020.
The Andrews Unverity student medical insurance changed for this new academic year. Previously they had Commercial Travelers through National Guardian Life insurance company. Effective 8/17/20, the Commercial Travelers/National Guardian Life medical insurance terminated.
Effective 8/18/20, Andrews Univeristy student insurance is now with AETNA Student Health Plan for the 20-21 academic year.
Virtual Office Advisory
Thursday, September 17, 2020
Noon – 1 p.m. EST
Join us for our upcoming September Virtual Office Advisory webinar and learn about:
You now have the option to submit pharmacy prior authorizations for Priority Health members electronically.
Save time and get faster pharmacy decisions
We know you spend substantial time on prior authorizations and that it’s a common pain-point for many practices. That’s why we’ve partnered with Surescripts to implement an electronic prior authorization (ePA) solution for Rx drugs that will eliminate the need for time-consuming paper forms, faxes and phone calls, and allow us to return faster decisions to you.
The entire bulletin can be found at: www.UHCprovider.com > Network Bulletin.
LANSING, MICH. A $25 million grant program for personal protective equipment (PPE) will allow medical facilities and other providers to keep their staff and patients safe, the Michigan Department of Health and Human Services (MDHHS) announced.
Aetna Better Health has sent a Provider Bulletin informing us of a NEW lockbox changes as of 6/15/2020; please see the attachment below
They also have sent a letter regarding an E & M coding letter explaining current practices and policies; please also see that attachment.
Attached below is Aetna's First Tier, Downstream and Related entities (FDR) Q2 Compliance newsletter.
The current healthcare landscape is rapidly changing. We understand the extraordinary challenges our Members face daily and how difficult it can be to keep up with the most recent COVID-19 developments. With this weekly newsletter, we will provide you the latest news trending in healthcare.
If you haven't visited our site in a while, we have also added a few new focus areas:
We’ve revised our PCP Incentive Program (PIP) and Comprehensive Primary Care (CPC+) Program to reflect updated HEDIS information. Several measures have added additional opportunities for gap closure and/or exclusion criteria. In addition, we’ve made changes to the Healthy Michigan Plan: HRA measure which will be effective with the next Filemart report release. HEDIS measure changes are effective July 1, 2020.
You’re busy, so this quick read will provide you with useful updates from UnitedHealthcare. This brief is designed to:
