News

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.

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.

Please see the attachments for the recent news from Meridian

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https://corp.mhplan.com/en/provider/michigan/meridianhealthplan/news/bul...

What’s changing?

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?

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

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

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.

Attached is a chart that will be useful to offices on how to navigate questions within the Priority Health portals.

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.

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!

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!

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

From CIGNA--

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

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.  

On Oct. 22, 2020, Governor Whitmer signed two bills (Public Act No. 234 and No. 235) into law that forbid out-of-network PARE providers from sending surprise bills to patients. Surprise billing, or balance billing, has never been allowed for our participating providers.

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.

There are three websites offered by Ambetter / Meridian Health as resources to providers and their offices:

Medicaid – Mhplan.com

Complete -  https://corp.mhplan.com/en/provider/michigan/complete/

Ambetter – ambettermeridian.com

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.

 From Humana:

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:

 Statewide reinstatements

o Arkansas

o Colorado

o Delaware

o Idaho

o Indiana

o Kansas

o Kentucky