From Humana:
The Centers for Medicare & Medicaid Services (CMS) published the 2021 Medicare Physician Fee Schedule (PFS) final rule on Dec. 1, 2020, expanding Medicare-covered telehealth services to similar services already covered under the Medicare program. Please note:
Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.
What you need to know
Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.
Examples of fraudulent requests:
An Update from Priority Health:
As COVID-19 vaccines begin to be more widely distributed in our communities, we’re sharing information on billing and reimbursement for the vaccines and administration.
You should not collect any member cost share, such as copays, for first or second doses of COVID-19 vaccines or administration of the vaccine.
UnitedHealthcare is extending the temporary suspension of select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide through Jan. 31, 2021. The temporary suspensions are effective from Dec. 18, 2020 through Jan. 31, 2021. (They were previously set to end on Jan. 8, 2021.)
Humana has provided us the attached Power Point presentation regarding their NEW authorization process -- Cohere. This process began on 1/1/2021.
Please read the details in this attachment about how to submit a request, the clnical review process, peer to peer consults, and many more details regarding this new authorization system.
Please read the attachment for the latest news from Priority Health!
In addition from Priority Health:
The 2021 PCP Incentive Program (PIP) manual is finalized and available for download. Visit 2021 PCP Incentive Program Manual (priorityhealth.com) to view.
2021 new measures
Please read the informational attachments for the latest from United Healthcare on COVID-19, Tele-health, The Administrative Guide for 2021, and much more in 2021.
Also, please connect with this link to sign up for future emails from UHC: Please visit: UHCprovider.com/subscribe to sign up!
Since the COVID-19 pandemic began, CIGNA has delivered timely accommodations to providers and customers, and ensured that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.
Please read the attachment for details on vaccines, treatments and extended coverage accommodations.
COVID-19 vaccines
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We want to keep you informed of our holiday hours at Lakeland Occupational Health. Dr. Boomus will be out of the office on December 22, through December 25 and Tuesday, December 29 through January 1, 2020. Dr. Boomus will be in the office on Mondays, December 21 & 28.
Please read the December 2020 issue of the United Healthcare Provider News Brief for all of the latest information from UHC..
In addition, COVID -19 authorization process requirement has been postponed until 01/04/2021; please see the attached document for further details
To remain in compliance with Medicaid billing requirements, on December 14, we’re moving to up-front claims rejections that have the missing or incorrect information listed below. Previously these were warnings.
The new upfront rejections included:
Attached are the Meridian Provider educational handouts for the month of December 2020. There is also important information on Ambetter which takes effect on 1/1/21. This is a Centene Ambetter brand change from Meridian Choice/Comm/HMO effective in 2021
To continue to support you and our members as COVID-19 cases rise in our communities, we’re extending many temporary changes into 2021. Get the complete list of temporary changes and their expiration dates.
In support of easing administrative burden during this pandemic, we (Meridian) are reinstituting many of our operational changes from the spring. If there’s anything we can do, please let us know and we'd be happy to champion it through the organization.
Humana has provided the first FAQ related to the COVID vaccine, and it will be updated weekly as new information is available.
Join us for our upcoming December Virtual Office Advisory webinar and learn about:
Cigna has entered into a new Strategic Alliance with Priority Health. This partnership enables us to leverage the best capabilities of both organizations, and deliver a health care experience in Michigan’s Lower Peninsula that is more predictable and simplified for providers and customers.
Cigna members will begin accessing medical care through the Priority Health network effective 1/1/2021
Please see the attached United Healthcare Network Bulletin regarding 2021 updates and changes to programs and policies.. Additionaly, please read the monthly handouts and bulletin..
As partners with you in your patient’s health, we want to keep you informed of the various member programs happening now through the end of the year, with the goal to help keep Medicare and Medicaid members, your patients, safe and healthy with more resources and support in addition to their doctor visits.
Like you, we are concerned with the unprecedented surge of COVID-19 cases in Michigan. We strive to understand the unique challenges different states face and determine how we can help.
In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial members for the entire state of Michigan through Dec. 31, 2020. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.
Attached are the Meridian Provider educational handouts for the month of November 2020.
We’re excited to share 2021 product updates for our Commercial and Medicare products. The information below provides an at-a-glance view of changes. For more detailed product information, reference the attachments included with this email or view a recording of our Oct. 15 Virtual Office Advisory webinar, focused on product updates.
Commercial formulary updates effective Jan. 1, 2021
In January and July of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs.
In 2020, we’ve made more than 66 enhancements, including 46 new drugs and changing 20 current drugs.
To help practices who are busier than normal in 2020 we’ll use our existing data sources to collect Medicaid PCMH incentive information.
As a reminder, the 2020 Medicaid PCMH incentive has 3 requirements:
There’s nothing you need to do. We’ll gather this information from the following sources:
Attached are the Meridian Provider educational handouts for the month of October 2020.
Take a peek at one of our top stories
Cigna launches five-year initiative to combat systemic racism
Take a peek at one of our top stories
Cigna launches five-year initiative to combat systemic racism
The attached Provider Bulletin No 179 was sent to the Medical Practice Group via fax blast today. ABH has asked us to inform practice managers within our network.
Provider Bulletin No 179 November Webinar! Coding Specific Topic: Closing HEDIS gaps for HEDIS 2021
Webinars date/time:
November 10 – 11:00 AM EST
November 11 – 2 PM EST
TOPICS:
Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.
Below is the UHC November Network Bulletin Summary. Please review and share with staff as needed. The entire bulletin can be found at www.UHCprovider.com > Network Bulletin.
Please read the attachement below fo rspecific details.
Please read the attachment regaarding news from Priority Health on a number of important requrements and changes.
Included in this newsletter are:
See the attachment for detils please.
From UHC:
Radiology notification regarding CPT codes being added to the Radiology Notification and Prior Authorization list. This will go into effect for claims with dates of service on or after Jan. 1, 2021.
There’s no question. It’s a different health care environment today. But with Cigna’s new virtual care reimbursement policy for commercial medical services, there’s one thing that doesn’t need to change: the connection you have with your patients with Cigna coverage – even if they can’t come into your office, and even beyond COVID‑19.
Fellow physicians and healthcare professionals:
The last several months have been unlike any other in our lifetime as we are navigating this pandemic together. However, I believe we will emerge on the other side in a stronger, better state. As we continue along this new normal together, I want to share two updates with you regarding reactivating standard authorization processes and new programs for your Humana patients to support the care they receive from you.
Reinstating Authorizations for COVID-19 Diagnoses
Please visit UHCprovider.com for the full news brief.
There is informaiton on a New prior Authorization and Notification tool, information on the expansion of the Dual Special Needs program, and many more important updates
Providers logged into a provider portal account can see health conditions and lab values and prioritize patient visits based on gaps in care using the Patient Profile tool.
With the Patient Profile tool you can:
Below is a summary of the October 2020 Network Bulletin. The entire member can be found at www.UHCprovider.com > Network Bulletin. in addition, there is 2020 Flu Shot informaiton also attached. Please review and share with staff.
