Attached is the 2021 Provider Manual from Humana to reference in offices.
From Meridian on upcoming switch to authorization process:
Beginning July 1, 2021, National Imaging Associates, Inc. (NIA) will provide utilization management for Interventional Pain Management (IPM), outpatient rehabilitative and habilitative physical medicine services for Meridian’s membership. This program is consistent with industry-wide efforts ensuring that IPM and physical medicine services provided to members are consistent with nationally recognized clinical guidelines.
McLaren has provided this below information in their June 2021 Provider Network Update:
AUTHORIZATION CHANGES - EFFECTIVE AUG. 1, 2021
Effective Aug. 1, 2021 McLaren Health Plan will require authorizations on all inpatient stays with a COVID-19 diagnosis. The authorizations are being reinstated for all lines of business, at all facilities, excluding DME. Facilities with an APM agreement should follow the APM guidelines for authorization requests.
United Healthcare has provided these June 2021 monthly handouts.
- June 2021 Network Bulletin Summary
- UHC HMP HRA Provider Incentive FAQ
- Distance Learning
- COVID- 19 Update
- National Kidney Foundation of Michigan Diabetes Prevention Program Online Workshop
From BCN to offices:
Dear Medical Care Group Business Administrator:
The attached 2021 issue of BCN Partners in Care mailed in May to all contracted Blue Care Network providers, one copy per address.
The cover letter focuses on the lessons learned from the COVID-19 pandemic, particularly the versatility of providers, the need for more equity in health care and Blue Cross and BCN’s focus on behavioral health support for members.
As of 1/1/21, Lakeland Care Network is no longer contracted with Cigna. Priority Health is the contracting entity now. Attached below is a Quick Reference Guide we hope will help clarify this new alliance.
Please see the attachments for the recent news from Meridian
Have you been enjoying these monthly updates? Would you prefer to receive them via email? Visit the Bulletins page for your state and fill out our sign-up form to receive the monthly update directly in your inbox!
Provider Bulletins for May 2021:
- Provider Bulletin No 185- The Availity Provider Portal is now open to all Aetna Medicaid Providers
- Provider Bulletin No 186 – MI SNF Liberalization Status- COVID 19 Communication Update ( effective 4.19.2021) Changes in Prior Authorization/Precertification and Admissions Protocols for Aetna Better Health of Michigan.
- Provider Bulletin No 187-Covenry payer ID Number 25133 is No Longer Valid - Correct Aetna Better Health of Michigan payer ID Number 128MI.
Per MDHHS guidance, we’ve updated our policy in 2021 for Medicaid plans to allow members a 90-day Transition of Care window. Providers can submit for Transition of Care authorizations on our website.
What is Transition of Care?
Please see the below Provider Bulletin from United Healthcare for all of the latest news and updates from UHC.
Effective May 1, 2021, Lakeland Care Network has entered into an agreement with McLaren Health Plan for commercial business as well as Medicaid. All Lakeland Care Network credentialed providers are automatically participating for both lines of business. Their commercial plans are called: McLaren Health Plan Commun
Quick reference guide for providers
Starting January 1, 2021, Priority Health and Cigna have entered a Strategic Alliance which means:
• Cigna commercial group members that get care in Michigan can access the Priority Health preferred provider organization (PPO) network.
• Priority Health commercial group members that get care outside of Michigan have access to the Cigna network.
Please see the attachment for further details and Sample ID Cards
United Healthcare has provided these informational handouts for May 2021:
- Network News Bulletin
- Medicaid Managed Care Plan Coverage of Automated Home Blood Pressure Cuffs
- Wellhop program for Mom and Baby
- MDHHS Bulletin : COVID-19 Vaccines for Children (VFC) Pharmacy Expansion
IMPORTANT INFORMATION FROM CIGNA
Extending key COVID-19 accommodations through July 20, 2021
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.
From ABH: April 2021 Provider Bulletins:
- Provider Bulletin No 184- Aetna Portal Upgrade – We are pleased to announce the availability of our new and improved solution for verifying member information and submitting claims to Aetna Better Health. Within the next two months, ConnectCenter will replace Emdeon Office, giving you a more reliable, more complete way to submit claims, all at no cost to you. Get started TODAY! Go here to get started right now.
Aetna now offers providers ability to submit appeals electronically via Availity as of 1/25/21. Attached is a handout that has screen shots and tips of the process with explanations that can help provider offices use the new process!
Attached is a chart that will be useful to offices on how to navigate questions within the Priority Health portals.
UnitedHealthcare Prior Authorization Program Changes – COVID-19
This announcement is applicable to all in-network hospitals and all in-network skilled
nursing facilities (SNFs) in the Detroit-Warren-Dearborn, Kalamazoo-Portage, Lansing-
East Lansing and Flint, Michigan Metropolitan Statistical Areas (MSA).*
During the COVID-19 national public health emergency, UnitedHealthcare is temporarily
The latest COVID-19 updates
As the COVID-19 vaccines continue to be distributed across the country, we are committed to ensuring providers have the latest information related to our response to COVID-19. The following information outlines some of the latest updates, including increased vaccine reimbursement, encouraging patient vaccinations, our coverage of COVID-19 tests, and accommodations we continue to make during the public health emergency (PHE) period.
Please read the attachment for all of the latest details from CIGNA.
From Priority Health:
Thanks to your feedback, we’re planning several enhancements to GuidingCare authorization process in 2021. These changes will speed up some authorizations, giving your practice more time to focus on patient care.
Today, the following enhancements start:
Priority Health has shared a handout that helps offices navigate questions as they may arise. Plese read and print the attachment for all of the details!
The Telehealth PCP is a new plan that just launched in 2021 for Individual members. The plan offers virtual-first primary care coverage through our partner, Doctor on Demand®. However, by choosing this plan, members are assigned a PCP from Doctor on Demand. Any in-person care needed is referred back to the Priority Health HMO network.
Individuals can choose their own plan during open enrollment either through the marketplace, their agent or Priority Health directly.
COVID-19 news from UnitedHealthcare
Billing and temporary provision updates, member outreach to encourage vaccinations
UnitedHealthcare is revising our COVID-19 resources to reflect additional billing guidance, and updating a number of temporary cost share provisions that were established as part of the COVID-19 response. Here’s a high-level summary of the changes and effective dates
Please read the attachment for all of the NEW details from United Healthcare!
Attached you will find the monthly handouts from Meridian for the month of March 2021:
Provided to you from United Healthcare:
Please review the attached Medicaid home blood pressure cuff coverage grid that has been created by the State of MI. The grid can be used by providers to check inclusion criteria, preauthorization requirements, and special instructions specific to each to the UHC managed care plan prior to prescribing blood pressure cuffs to patients with hypertension for blood pressure self-monitoring. .
Michigan Department of Health and Human Services (MDHHS) Blood Pressure Cuff Coverage Grid
Dear Medical Care Group Business Administrator,
If you or any of your physicians participate in electronic claims transactions with Blue Cross or BCN, you need to take action. Please forward this information to your billing contacts to ensure there are no gaps in communications.
AS A TRUSTED SOURCE, YOU CAN MAKE THE DIFFERENCE IN GETTING VACCINE HESITANT PATIENTS PROTECTED
Only 26% of respondents say they have asked a health care professional for information about the vaccine so far. – Kaiser Family Foundation Report on Vaccine Hesitancy
From our Partners at United Healthcare:
Many of you are aware that Microsoft is no longer going to support IE11 (Internet Explorer) starting 8/17/21. We have been partnering with UHC Digital on an education strategy to our Core/Strategic providers who are using EI11. Since Link and the Provider Portal will be impacted it is important our providers make the transition over to a new browser.
UnitedHealthcare online tools and web compatibility
Effective April 5, 2021, you will be directed to GuidingCare to request musculoskeletal authorizations, instead of eviCore. Our portal will direct you automatically to GuidingCare as you start to enter the authorization details.
There are no new authorizations or other changes currently. You’ll continue to use eviCore for high-tech imaging and genetic testing authorizations. Retro authorizations for musculoskeletal services will continue to be processed by eviCore.
United Healthcare has provided the March informational handouts. The topics include:
- March 2021 Network bulletin (powerpoint presentation)
- EDI - Self Service Comparison Guide
- NEW program: Wellhop for Mom and Baby
- MiHIA Diabetes At Home Assistance
- Diabetes Prevention Online Program Workshop
Please read the attachments for details.
Select COVID-19 temporary cost share waivers are extended
Aetna Medicare member IDs are changing from the alpha numeric mix of MEB or MED**** to 12 digit numbers starting with ‘10’. See below on the info/details and ID card examples
Member ID numbers are changing
- Member ID numbers are 12 digits and start with ‘10’
- Members will be mailed new ID cards
If a claim for a 2021 date of service is submitted using an older 2020 HMO member ID, claims logic is in place to evaluate the member ID and the DOS and redirect the claim to the appropriate claims platform.
Aetna Better Health has provided these flyers as their monthly updates and NEW fax numbers for offices:
Provider Bulletin No 182 – ABH MI Prior Authorization Fax Numbers – effective 1.29.2021
There are three websites offered by Ambetter / Meridian Health as resources to providers and their offices:
Medicaid – Mhplan.com
Ambetter – ambettermeridian.com
Please see the attached fax notification that is going to be sent to offices regarding the prior authorization vendor change for MeridianHealth (Medicaid) and WellCare (Medicare). This change is going to go into place effective 4/1/21.
Please read the attached newsletter for February 2021 from UHC for all of the latest details.
A preview: To ease the administrative burden you may be experiencing in submitting COVID-19 vaccine administration claims for Medicare beneficiaries, UnitedHealthcare has made it easier for you to find a member’s Medicare ID number. We also have a tool to help members find state and county health department resources on FDA-authorized vaccines, as well as materials you can use to encourage your patients to wear masks – a critical step in reducing the transmission of COVID-19.
The dates for our 2021 behavioral health collaborative care (BHCC) meetings are now available. Provider organizations are required to attend at least three Priority Health-sponsored BHCC meetings as part of eligibility requirements for the BHCC incentive.
Other BHCC eligibility requirements include:
- Have PCMH recognition in the program year
- Attend at least one BHCC learning event in the program year
As we continue to monitor the status of COVID-19 cases and review procedure data in the 22 states listed below, we are implementing changes to authorization requirements.
Humana is reinstating authorization requirements for Medicare Advantage and commercial members for skilled nursing facilities (SNFs) for dates of service on or after March 1, 2021, in these states:
If there are questions regarding veterans and their coverage, please visit the site below for the latest updates: