News

Thank you to those of you who could join us on the evening of October 25 for the BCN/BCNA/MAPPO Gain Share Contract and Program updates for 2024.  We know some of you had conflicts and were not able to attend, so we recorded the meeting.  Due to the size of the file, we are pushing the recording of that meeting through your EDIFECS accounts tomorrow.  It sometimes takes several hours for those to go through, so I’d give it until Wednesday to retrieve it. 

Dear BCN-Affiliated Medical Care Group Business Administrator:

Blue Care Network mailed additional letters in October 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics, or PGx, test as part of BCN’s new Blue Cross Personalized MedicineSM program.

Thank you all who joined us at the Hilton Garden Inn for our annual payor conference.  It was so much fun to get together again and see our friends in person! We hope you found our conference helpful and, as promised, below are the presentations by our payor partners:

Beginning Oct. 19, you’ll receive biweekly PriorityActions emails that will include important and actionable information to help you work with us and care for our members, your patients.

Why is this change happening?

As we continue improving our communications to help us work together, we’re excited to launch a biweekly email that delivers important content to you on a consistent basis, reduces your inbox clutter and allows you to easily reference important content in one place.

We know how much hard work you put into population health and chronic condition management in your practices. We want to make capturing important information about your patients easier and more efficient so you can focus your time on what matters most – your patients, our members.

Dear BCN-Affiliated Medical Care Group Business Administrator:

Blue Care Network mailed additional letters in September 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics, or PGx, test as part of BCN’s new Blue Cross Personalized MedicineSM program.

The Centers for Disease Control and Prevention recommends a yearly flu vaccine for everyone ages six months and older as the best protection from this serious illness. Lakeland Care Network (Lakeland Care), in collaboration with Corewell Health, will offer drive-through community flu shots on the following dates:

Effective: September 13, 2023

United Healthcare has shared this informaiton and handouts with our offices:

Medicare: Charging patients for non-covered services.

Effective Jan. 1, 2024, Tezspire® coverage will shift from a medical benefit to a pharmacy benefit for commercial and individual lines of business.

What’s changing?

Beginning Sep. 1, 2023, coverage for the Tezspire autoinjector pen will be added to the pharmacy benefit as a Tier 4 medication with prior authorization criteria.

Beginning Jan. 1, 2024, Tezspire will no longer be covered under the medical benefit and the prefilled syringe will not be added to the pharmacy benefit. (See table below)

Lakeland Care Network offices have just today been notified of upcoming changes that will affect new credentialing applications this last quarter of 2023. This is due to new credentialing software implementation being implemented in late September 2023. Please read below the statement from the Corewell Health Medical Staff Office.

Thank you and please reach out if you have any questions.

Lakeland Care Network

Dear Corewell Health Provider Credentialing Stakeholders:

Attached you will find some of the latest literature from Community Plan for provider offices caring for UHC - CP members.

Humana announced this morning that effective October 1, 2023, they no longer will be quoting their Commercial product in Michigan.  Some employers will still have Humana Commercial for their teams, but by December 31, 2025, you will no longer have any Humana Commerical patients running through the Lakeland Care Network.

United Healthcare has shared it's July 2023 Network News with all of our offices.

Loeks Theatre ( via Lucent Health)  is now a new employer group that has joined the Lakeland Care Network.  The members of this employer are effective from 6/1/23 through 9/30/23.

Attached are sample cards for the office to refer to if needed when members visit our Corewell Health locations.

Some Cigna member claims submitted electronically by Michigan providers are being incorrectly denied due to a clinical edit. (The remittance advice will usually mention a missing or invalid diagnosis code.) We’re working hard to fix this as quickly as possible.

A message this morning from Priority Health:

As you may know, InterQual, managed by Change Healthcare, is experiencing a national outage. This outage impacts prior authorization processes for providers and payors across the country.

United Healthcare has shared their June’s Network News updates for June 2023

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