Latest information on the Change Healthcare outage:
Priority Health sent a PriorityAlert on April 2, 2024 with the latest updates on the Change Healthcare outage.
Change Healthcare communications archive:
You can visit the news & education page in your Provider Manual for an archive of communications we've sent about the Change Healthcare outage.
PHP highly recommends utilizing electronic prior authorization (ePA) as the preferred method for obtaining prior authorization for pharmacy prescriptions.
Self-funded plans administered by PHP TPA Services are provided with a unique identification that provides access to Lakeland Care Network providers who are contracted with PHP. Each patient member covered under a TPA plan will be assigned an individual identification card.
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/
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".
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:
Lakeland Care Network would like to share some current information and key facts regarding Measles.
Attached are three handouts for your reference. Please share with your offices.
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.
Review this important information to help you work with Priority Health and care for members.
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).
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:
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.
Review this important information to help you work with Priority Health and care for members.
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).
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.
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.
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.