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Latest news

Priority Health - NEW Automated Phone System for Claims Calls

December 6, 2017

Effective January 1, 2018, our Provider Helpline representatives will direct callers with claims questions to our automated phone system or their provider account on priorityhealth.com. This change should reduce the wait times for speaking to a representative.

Our representatives will still assist with all other concerns, including those regarding claim denials.

 

Priority Health - Medicaid Pharmacy NEW Narrow Network

December 4, 2017

Effective December 1, 2017 Priority Health will utilize a select, limited group of pharmacies as preferred for all outpatient Medicaid prescription fills.

In our Medicaid service regions (West Michigan and Southwest Michigan) there will remain approximately 220 approved pharmacies where patients can have prescriptions filled.   Many large retail stores will continue to be in the Priority Health Medicaid pharmacy network, such as:

·         Walmart

·         Meijer

·         Walgreens

·         Costco

·         SAM’s club

Priority Health - Call Center Services Changes

November 27, 2017

Our online accounts and self-service automated phone system allow you to have 24/7 access to information about claims, benefits and authorizations. One of the most popular features of these tools is being able to look up simple claim information, including check numbers, amount applied to a deductible or coinsurance, or the amount being paid to you.

To reduce our hold times for our provider call center, we’re going to direct those who have basic claims questions to self-service tools.

CHAMPS Requirement for UHC Community Plan

November 1, 2017

All current and new UnitedHealthcare Community Plan Michigan Medicaid providers, including out-of-state providers, are now required to access CHAMPS to register in the Michigan Medicaid program. Registering in the Michigan Medicaid program does not require you to be a Medicaid FFS provider.  Effective January 1, 2018, failure to enroll in CHAMPs will result in claim denials.

 

Please see the attachment for further details.

2017 Annual Payor Conference Reference Tools

October 25, 2017

Thanks to all who spent the afternoon with us last week 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.

Priority Health: eviCore Additional Education and Pay Information

October 12, 2017

We greatly appreciate your patience as we continue to optimize the eviCore experience. As you know, we are currently in the "educate and pay" phase, which gives you an opportunity to become more familiar with eviCore's clinical criteria. During this time we are also diligently working with eviCore to improve operational challenges.

Our process remains the same

As a reminder, our processes communicated on 8/22/17 remain the same, and will continue through the end of the calendar year:

Humana Requests for Provider Directory Updates

September 25, 2017

You get them all the time.. the faxes from Humana asking your office to update your provider information with Humana in accordance with federal provider directory standards.  Good news!  If your providers are part of the Lakeland Care Network, you do not have to respond to these anymore. Lakeland Care will take care of that for you!  If you are an LMP practice, you don't need to send them to the Medical Staff Office either.  

Priority Health - Update on eviCore Processes and Solutions

September 20, 2017

Educate and Pay Program

As we continue to work with eviCore to identify solutions and address issues we have faced since the program implementation this summer, we are moving into a new phase, the Educate and Pay program. With the new program there are new communications you will be receiving from eviCore and there are new actions you will need to take.

Priority Health - New changes for some eviCore prior auths

July 26, 2017

  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. 

New claimsLink App for United Healthcare

March 30, 2017

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:

ACA & MACRA in the New Political Environment: How to Thrive in Value-Based Health Care - Follow Up

March 16, 2017

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

2017 myHealth Biometric Screening Forms for Lakeland Employees

February 15, 2017

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.

MPIE Webinar - Using Informed Consent and Advance Directives to Improve the Physician/Patient Relationship and Mitigate Loss

February 9, 2017

You are invited to attend Michigan Professional Insurance Exchange’s webinar titled….

USING INFORMED CONSENT AND ADVANCE DIRECTIVES TO IMPROVE THE PHYSICIAN/PATIENT RELATIONSHIP AND MITIGATE LOSS

February 22, 2017 | 12-1 p.m.

Register now!

The lack of informed consent:

General Medical Staff Meeting Scheduled

February 2, 2017

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.

Priority Health NEW Online Prior Authorization tool

January 31, 2017

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.

Gov. Snyder Appoints Dr. Kolinski to Michigan Board of Athletic Trainers

January 30, 2017

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.

2017 Biometric Screening Form for Whirlpool Employees

January 19, 2017

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.

Quick Guide to Cigna ID Cards

January 13, 2017

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.

Non-Discrimination Poster Required in All Lakeland-Owned Practices

January 12, 2017

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.

Kruger Plastics Changes Payor

January 12, 2017

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.

Affirmant Health Partners October 2016 Newsletter

October 25, 2016

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.