Priority Health has suspended some criteria for spine/joint procedures.
The eviCore prior auth tool went live in June for all in-network musculoskeletal and spinal procedures, genetic testing, and advanced diagnostic imaging. Since the launch, Priority Health has identified some technical issues that need to be resolved to follow the guidelines originally outlined.
The Michigan Department of Health and Human Services is requiring a change to the Federally Qualified Centers (FQHC), Rural Health Clinics (RHC) and Tribal Health Centers (THC) claim format for billing Medicaid services.
New authorizations and our partnership with eviCore will launch on June 19, 2017.
The partnership with eviCore will optimize health outcomes through a focus on clinical appropriateness includes new authorizations for the following services:
claimsLInk will be rolled out to UnitedHealthcareOnline.com users. Offices will be emailed when the new app is available to your office. After you receive the email, please sign in to the UnitedHealthcareOnline.com using your Optum ID and click on either Claim Status or Claim Reconsideration on UnitedHealthcareonline.com. A pop-up box will give you the option to try claimsLink.
With claimsLink, you can:
The Lakeland Medical Office Association (LMOA) invites you to attend our April luncheon and meeting.
PROGRAM: Office Practice Risk Management: Lessons Learned from Claims
The Michigan State Medical Society presented yesterday at the March 2017 Lakeland Medical Office Association (LMOA) meeting. Upon numerous requests, we have included the PPT presentation given at this meeting by our presenter. A thank you to Joshua Richmond, Director of Physician Engagement & Membership, Michigan State Medical Society.
The program topic: ACA & MACRA in the New Political Environment: How to Thrive in Value-Based Health Care
The Lakeland Medical Office Association (LMOA) invites you to attend our March luncheon and meeting presented by the Michigan State Medical Society.
PROGRAM: ACA & MACRA in the New Political Environment: How to Thrive in Value-Based Health Care
ASR and Lakeland will be migrating Lakeland benefit plan enrollees away from using their social security numbers and instead use a new, unique member identification number effective March 1, 2017. Please note the following:
You are invited to attend Michigan Professional Insurance Exchange's webinar titled......
There has been quite a bit of confusion among Lakeland Care practices regarding Aetna Better Health, so we felt a brief explanation is in order.
Lakeland offers associates and spouses, on the medical plan, to earn a wellness incentive through participation in the myHealth program. The myHealth program is a voluntary program, and it is the participants responsibility to submit their biometrics. The myHealth program is an outcomes based health contingent program where participants must meet biometric goals. If the targets are not met, participants may earn the same reward by participating in Alternate Satisfaction Activities. Members who wish to participate must submit biometrics by 5/31/2017.
USING INFORMED CONSENT AND ADVANCE DIRECTIVES TO IMPROVE THE PHYSICIAN/PATIENT RELATIONSHIP AND MITIGATE LOSS
February 22, 2017 | 12-1 p.m.
The lack of informed consent:
The next General Medical Staff meeting will be held at the Lake Michigan College Mendel Center on Tuesday, April 25, 2017. Dinner will be served promptly at 5:30 p.m. This meeting is mandatory for all medical staff of Lakeland Health. Invitations will be sent to the provider's home address and also to their email on file with the Medical Staff Office. RSVPs are required.
Beginning on Monday, January 23, 2017, Priority Health has a new online prior authorization automation tool, Clear Coverage™. This NEW system will replace their original fax process; the patient services which need a prior authorization will remain the same, but the way they are obtained is made easier.
Clear Coverage lets you request authorizations online, and offices will receive immediate responses, including automatic authorizations for some procedures, all while making the authorization process quicker and easier.
The Lakeland Medical Office Association (LMOA) invites you to attend our February luncheon and meeting.
PROGRAM: Don't Manage, Coach!
LANSING, Mich. – On January 25, 2017, Gov. Rick Snyder announced the appointment of Michael Kolinski of Kalamazoo to the Michigan Board of Athletic Trainers. Housed within the Department of Licensing and Regulatory Affairs, the 11-member board assists in overseeing the licensure and practice of athletic trainers.
“I thank Michael for his willingness to serve on this board and am confident he will have a positive impact within the athletic training community,” Snyder said.
Whirlpool Corporation provides rewards in the form of medical plan premium credits and account incentives when covered members complete the biometric screening and meet biometric goals. Members who wish to participate must meet the goals or alternative goals by December 1, 2017 to receive 2018 rewards.
NEW for 2017: Whirlpool employees will no longer be tested for nicotine, but will need to self-report as nicotine-free during Annual Enrollment, or as a life event through the Whirlpool Benefits Center.
Here's a quick guide that Cigna is offering to help medical offices understand Cigna ID card information.
This tool can help define and clarify information that appears on Cigna's most common customer ID cards. It can also help you understand the requirements associated with their various plans, allowing you to quickly and efficiently serve your patients.
On May 13, 2016 the Department of Health and Human Services (DHHS) made changes to section 1557 of the Affordable Care Act.
Section 1557 is a “non-discrimination” modification that bans discrimination in healthcare or health coverage on the basis of: race, skin color, national origin (including immigration status and English language proficiency). Section 1557 is distinct amid Federal civil rights laws due to its specific address of discrimination in health programs and activities.
Effective 1/1/17, Kruger Plastic Products will no longer use Heritage Consultants as their payor. They will continue to have access to the Lakeland Care Network, but will use Professional Benefit Administrators as their payor. Look for new ID cards and update your system so claims go to PBA instead of Heritage.
The Lakeland Medical Office Association (LMOA) invites you to attend our January luncheon and meeting.
PROGRAM: A Trip Through EPIC
The Lakeland Medical Office Association (LMOA) invites you to attend our November luncheon and meeting.
Program: HIPAA Now
You are invited to attend Michigan Professional Insurance Exchange’s webinar titled….
How to address medical errors that are not your own
November 16, 2016 | 12-1 p.m.
Quick Summary
Complete Network Bulletin Available Here
TABLE OF CONTENTS
Front & Center
• Tell Us About Your Experience With Us
• New National Drug Code (NDC) Requirement Policy
• Communication Effectiveness Survey
Quick Summary
Complete Network Bulletin Available Here
TABLE OF CONTENTS
Front & Center
• Communication Effectiveness Survey
• New and Updated Link Applications
• Tune in to UHC On Air
• Termination of the ICD-10 Code Look-up Tool
• Tell Us About Your Service Experience
Please read the attached newsletter from Affirmant Health Partners, our state-wide clinically integrated network. These newsletters will available monthly, and will serve to provide the most up to date information on our network.
Here are the handouts as well as the presentation by Aetna/Cofinity from the annual Lakeland Care Payor Conference held yesterday at the Hilton Garden Inn.
Thanks to all who spent the afternoon with us yesterday at the annual Lakeland Care Network Payor Conference. We hope it was a valuable day for you and your office or department. Attached are presentations for your reference.
(Aetna's presentation and handouts will be attached in a separate news article as we are limited to 10 attachments per article.)
Meridian Health and McLaren Health Plan have also confirmed with Lakeland Care that physicans who see any Medicaid, or even simply refer Medicaid patients to Lakeland for any services, MUST ENROLL and ATTEST to their information within the CHAMPS System. Please note that enrolling in CHAMPS does not require you to be a Medicaid FFS Provider.
Here's how you enroll in CHAMPS:
1. Go to www.michigan.gov/mdhhs
2. Click on “Doing Business with MDHHS” Icon (top of page)
The letters from ASR that were sent to all of the Lakeland Care Network physicians, were sent in error. Unfortunately, it’s created confusion, so here's a little clarity on the whole thing.
HAP is a network in the Detroit area and is expanding in the east and into northern Michigan. HAP bought ASR about 5 years ago and they are currently marketing their expansion into Northern Michigan. These letters were intended for the physicians in the eastern and northern Michigan expansion areas.
United Healthcare has announced that they will no longer be participating in the individual insurance marketplace for 2017 for both Michigan and Indiana, as well as 24 other states. This will leave only Blue Cross Blue Shield and Priority Heath as options for Michigan residents looking to sign up for insurance on the exchange. For Indiana residents, PHP of Northern Indiana has also opted to exit the Indiana individual marketplace as well as its Individual Product line for 2017.
In case you haven't heard, UnitedHealthcare Community Plan (Medicaid) is now requiring all new providers to be enrolled in CHAMPS, due to State policy changes. They warn that failure to enroll could cause unnecessary delays in payment. This applies to both rendering and ordering/referring providers that are servicing Medicaid members. As they receive rosters from Lakeland Care, they will validate each new provider to ensure they are enrolled in CHAMPS. If the provider is not found in CHAMPS, Lakeland Care will notify your office.
There will be an information session and breakfast for the Office/Practice managers, nurses, and staff of any surgery offices in Niles, Watervliet, and St. Joseph regarding the new surgical optimization clinic called "Presurgery Planning." The presentation will be on Thursday, September 22, from 0700 - 0800 in the Upton Conference room 5 (SJ) and will be videoconferenced to the the Small Dining Room in Niles. Breakfast will be served in both locations.
The Lakeland Medical Office Association (LMOA) invites you to attend our September season kick-off luncheon and seminar. **Please note this is a half-day seminar**
Program: Documentation - The Key to Preventing Medicare Recoupments
The New Gateway to UnitedHealthcare’s Online Tools. It’s here! Click here to learn more about Link and view answers to frequently asked questions. If you have questions, please call the Link Support at 866-842-3278 option 3, 8 a.m. to 10 p.m. Monday through Friday. Thank you.
Here's a sneak peek at the first program that the Lakeland Medical Office Association will bring to you for our 2016-2017 season!
Come and learn from Medicare what they want in your documentation, because we all know if the documentation isn't there, you can risk losing a lot of money.
We encourage you to bring your physician(s) for this presentation, so block their calendars—and yours—and we'll see you at our season kickoff meeting on Wednesday, September 28th!
Cigna's newest edition of Network News for July 2016 includes these topics:
A New Look. Better Service at CignaforHCP.com on page 3
Introducing the new Care Allies on page 7
Cigna ranks #1 on 2016 PayerView Report on page 8
Taking action to fight the opioid epidemic on page 19
These highlights and more are found in the attached newsletter.
As of October 1, Priority Health will require the inclusion of National Drug Codes (NDC) on claims for services that include drugs. This aligns Priority Health’s billing requirements with many national payers.
Claims submitted on or after Oct. 1, 2016 without the NDC codes will be rejected. This applies to all Priority Health plans, and applies to all drugs on the claim (even if the drug is not a covered benefit).
More information:
