News



March 27, 2024

United Healthcare: UHCProvider.com and Getting Answers Quickly

From our partners at United Healthcare, they have launched a new program for our offices to get questions answered quickly!

If you are looking for a way to lessen the time you spend on administrative tasks, you can now use their new chat feature located within the United Healthcare Provider portal. See the attachment for details.

For further details, another option is to visit: https://www.uhcprovider.com/  

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March 21, 2024

New Contract with Aetna Better Health Medicaid

Lakeland Care Network has signed a contract with Aetna for their Medicaid product. All participating Lakeland Care providers are participating with Aetna's Medicaid for dates of service 1/1/24 and forward.

Lakeland Care already contracts with Aetna Better Health for their Dual Eligible product, which is called "Aetna Better Health Premier."  This newly-signed contract is for Aetna's Medicaid product which goes under the name of "Aetna Better Health".  

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March 18, 2024

Meridian: Post Service Appeals Changes and New Form

Meridian is now accepting post service appeals via fax. When faxing the appeal, please include the attached cover page as well as the claim number associated with the appeal when faxing, as the first page of the submission so that it can be appropriately routed. The attached document indicates that the appeal cover letter can also be mailed if preferred.

The fax numbers for each LOB (MMP and Medicaid) are below:

  • Michigan Medicaid Post service appeal: 833-592-0658 
  • Michigan MMP Post service appeals: 833-957-0439
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December 11, 2023

UnitedHealthcare: Community Plan 2023 Quarter 4 Newsletter

Michigan scholarships grow doula workforce

UnitedHealthcare Community & State recently invested $198,000 into regional development of the doula workforce. With this investment, participants are able to apply for scholarships to pursue doula training and relevant continuing education. Along with 20 training scholarships available in Michigan, UnitedHealthcare is working to improve birth outcomes and access to holistic support by building relationships with local doula organizations.

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November 29, 2023

Blue Care Network: November 2023 Pharmacogenomics Mailing and Invite to Sign Up for Regular PGx Reports

Blue Care Network mailed additional letters in November 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.

One or more of your physicians is included in this additional mailing. Attached is a generic copy of the letter mailed. In addition, each physician received a list of his or her patients being offered the test, a Quick Start Guide and a copy of the member communication (also attached).

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November 20, 2023

Priority Health: PriorityActions Issue November 16, 2023

We’ve been recognized as a top performer by the National Committee for Quality Assurance (NCQA)

The National Committee for Quality Assurance (NCQA) has given our Medicare HMO/POS plans 4.5 stars (out of 5), making them the top-rated Medicare plans in Michigan and among the highest-rated plans in the nation.

NCQA also recognized our commercial and Medicaid plans:

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November 14, 2023

Blue Care Network: Follow-up from 2024 BCN/BCNA/MAPPO Gain Share Contracting Meeting

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.   

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October 31, 2023

Blue Care Network: October 2023 Pharmacogenomics Mailing and Invite to Sign up for PGx Reports

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.

One or more of your physicians is included in this additional mailing. Attached is a generic copy of the letter mailed. In addition, each physician received a list of his or her patients being offered the test, a Quick Start Guide and a copy of the member communication (also attached).

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October 31, 2023

Priority Health: Observation Stays Policy Update

Priority Health has updated our observation stays policy to align with industry standards. Observation stays will now be reimbursed up to a maximum of 72 hours, across all plan types. Stays exceeding 72 hours will not be reimbursed.

This change aligns with CMS policy which defines observation stays exceeding 72 hours as medically unlikely. It will also support our shared goal of ensuring our members, your patients, get the right care in the right setting.

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October 27, 2023

Lakeland Care Annual Payor Conference Documents

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:

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October 24, 2023

Priority Health: Meijer Specialty Pharmacy No Longer a Participating Network Specialty Pharmacy effective January 1, 2024

Beginning Jan. 1, 2024, Meijer Specialty Pharmacy has chosen to no longer participate in our specialty pharmacy network for commercial and individual members. This change only impacts drugs covered under the pharmacy benefit. Drugs covered under the medical benefit aren’t affected.

Medicare and Medicaid members can continue to use Meijer Specialty and retail pharmacies for all their prescriptions. All members may continue to use Meijer’s retail pharmacies for their prescriptions that don’t require a fill at a network specialty pharmacy.

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October 9, 2023

Priority Health: Humira Coverage Ending — Replaced with Biosimilars for Commercial Members effective Dec. 31, 2023

To maintain our commitment to providing our members with the most effective therapies at the lowest possible cost, Humira coverage will end for our commercial group and individual members on Dec. 31, 2023. This includes both new-start and existing prescriptions.

Humira will remain on the Medicare formulary, with prior authorization requirements, through 2024.

Effective Oct. 1, 2023, coverage for the Humira biosimilars, Hadlima and Adalimumab-adaz (manufactured by Sandoz) was added to our Medicare, commercial and individual member formularies.

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October 9, 2023

Lakeland Care Network Annual Payor Conference October 18, 2023 Registration

The Lakeland Medical Office Association invites you and/or your staff to attend our October luncheon and half-day meeting, sponsored by the Lakeland Care Network.

Program: Lakeland Care Network’s Annual Payor Conference

This year’s Payor Conference will feature the major payors in our market – including those who have Commercial, Medicare, Medicaid and Dual-eligible products.  Lakeland Care will also provide an update on our network's current projects and future initiatives.

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October 4, 2023

Blue Care Network: September 2023 Pharmacogenomics Mailing and Invite to Sign Up for PGx Reports

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.

One or more of your physicians is included in this additional mailing. Attached is a generic copy of the letter mailed. In addition, each physician received a list of his or her patients being offered the test, a Quick Start Guide and a copy of the member communication (also attached).

Read more



September 13, 2023

Priority Health: 2024 Supplemental Data Submission Details & Transition Support

As healthcare continues to transition into the digital space, we’re adapting our data strategy to follow suit. 

We announced in June that Patient Profile and the PIP_70 report will be retired with the close of the 2023 PIP performance year. Beginning with the 2024 performance year, we’ll accept only the following supplemental data sources for quality gap closure: 

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September 13, 2023

Blue Cross Blue Shield: Continues to Pay Claims During Union Work Stoppage as of September 13, 2023

Blue Cross Blue Shield of Michigan has experienced a work stoppage with our UAW-represented workforce. While we work to reach a labor agreement, please be assured that we will continue to process and pay your healthcare claims.

Your provider offices should continue to submit claims as normal. We will process and reimburse healthcare practitioners throughout the work stoppage. All of our benefits and billing requirements remain the same.

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September 5, 2023

Priority Health: August 2023 medical policy updates

Our Medical Advisory Committee (MAC), comprised of network physicians contracted with Priority Health, met this month and approved a series of medical policy updates. All updates are outlined in our policy updates webpage; below is a new policy we want to draw your attention to.

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August 9, 2023

CIGNA: Network News for Q3 of 2023

If you’re a registered user for the Cigna for Health Care Professionals website and have the Claim Search entitlement, you can now view notifications in the Message Center for claims that have been processed, pended, or denied. The Message Center can automatically provide daily emails informing you of these claim status changes or you can set your own preferences.
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