News

Priority Health is offering an one hour webinar on thursday, June 8, 2023 at noon on the topic of Virtual Office Advisory.

Topics include:

• July 1 formulary changes
• Medicare quality updates
• Medicaid quality updates
• GuidingCare
• PHE ending

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 has provided an update:

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 Advantage^SM members who are eligible for the Landmark Health high-intensity in-home care program for members with multiple chronic conditions.

 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)

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.

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.

On May 11, 2023, the COVID-19 public health emergency (PHE) is scheduled to end.

As previously communicated PHPs new partnership with Valenz Health for prior authorization services goes live May 1, 2023.

Below is the full list of contact information for Valenz Health:

Attached you will find the monthly updates for April 2023 from our partners at United Healthcare.

• Medicaid changes to dental  coverage effective April 1, 2023
• UHC Network News for April 

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. 

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.

9-day turnaround time

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.

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....

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.

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.

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.

Dear BCN-Affiliated Medical Care Group Business Administrator:

From United Healthcare, please read the provided attachement for the latest updates as of March 2023.

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.