Providers

February 12, 2025

Blue Cross and BCN invite you to learn about the new MCG webpage in the Provider Collaboration Portal

Blue Cross and BCN announce the availability of a new MCG webpage within the current Blue Cross Blue Shield of Michigan Provider Collaboration Portal. This new webpage will be available, Wednesday, Feb. 19, 2025, and will provide you with one location to find announcements, documents and events related to your Blue Care Network and BCN AdvantageSM contracts.

 An informational session covering site features, functionality and user access will be held on Wednesday, Feb 19, 2025, from 11:30am to 12:30pm. Please plan to attend this session to learn how to use this new site.

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February 10, 2025

PriorityActions - February 6, 2025

* New authorization requirement for renal denervation, effective Apr. 6, 2025
* Reminder: Call backs aren’t available for missed peer-to-peers for inpatient cases
* Seeing why a claim denied is now easier than ever in prism
* Reference prism for denial details instead of ERA/835 files
* Updated 2025 PIP & DBM manuals are available
* Rationale for excluding ASO / PPO from 2025 PIP Transformation of Care measures
* Register now for our February 20 product tips & reminders webinar
* 2025 D-SNP MOC training is now available
* We’re allowing more time for audit appeals, effective Jan. 1, 2025
* Get at-home colorectal cancer test kits for your eligible Priority Health patients
* Get our winter Physician and practice news digest and our Medicare/Medicaid Quality newsletter

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February 4, 2025

Humana Physician News - February 2025

* Streamline your workflow: Availity Essentials adds IPA and delegated entities
* New rule improves prior authorization process
* New study shows CenterWell Pharmacy benefits heart failure with reduced ejection fraction patients
* Artificial intelligence adoption in the
value-based era
* NEW! Watch the Stars condition management overview video
* Complete your required 2025 training
* NEW! Go365 provider toolkit puts patient well-being front and center
* The holidays and substance use disorders

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January 28, 2025

PriorityActions - January 23, 2025

* Updated TurningPoint provider training guide now available
* Medicaid formulary changes coming Feb. 1, 2025
* Register now for our January 30 billing & coding webinar
* NCQA’s 2025 HEDIS audit is underway
* Reminder: HMA members have access to Priority Health’s network

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January 13, 2025

PriorityActions - January 9, 2025

* Non-urgent inpatient hospital transfers will require prior authorization before transfer starting Mar. 10, 2025
* New & updated billing policies are now available
* Reminder: Corrected claims must include the original claim ID

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January 6, 2025

PriorityActions - December 19, 2024

HEDIS & PIP reporting updates for the 2024 and 2025 performance years

We’re sharing several updates related to HEDIS and PCP Incentive Program (PIP) reporting: 

2024 performance year information

December Filemart reports include historical data
Your December 2024 PIP reports include historical data, including care gap closure and member exclusions for the following multi-year measures: 

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January 6, 2025

ABH: January 2025 Informational Handouts

Please review the updated attachments sent via fax blast or USPS mail to all providers.  

 

  • Provider Letter: Edifecs Smart Trading platform - effective 1.20.2025
    • Enhancing claims EDI intake editing
    • Provider EDI claim submission processes will NOT be affected by this change

 

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January 6, 2025

LMOA January 15, 2025 Speaker Presentation

The Lakeland Medical Office Association invites you to attend our January luncheon and seminar.

Title:   Connecting Through Social Styles:  Strengthening Teamwork in the Office

Speaker:          Kim Olson, Sr. Organizational Development Specialist
HR Talent and Culture, Corewell Health South

Date:                  Wednesday, January 15, 2025

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December 9, 2024

PriorityActions December 5, 2024 Issue

Highlighted in this issue of PriorityActions:
*New resources available for the HMA product, launching January 1
*Reminder: the best way for practices to communicate with us is through prism

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November 25, 2024

PriorityActions November 21, 2024 Issue

 

REQUIREMENTS AND RESPONSIBILITIES

November 2024 medical policy updates 

Our Medical Advisory Committee (MAC), comprised of Priority Health network physicians, met in November and approved a series of medical policy updates. Below is a summary of the updates made. 

New medical policies & policies addressing updated coverage

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November 11, 2024

PriorityActions November 7, 2024 Issue

TRAINING OPPORTUNITIES

Register now to learn about our Jan. 1 formulary changes on Nov. 21 

Join us for a webinar to learn more about upcoming formulary changes for all Priority Health plan types, as well as other pharmacy updates. This session will cover: 

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November 5, 2024

LMOA November 2024 Presentation and Registration

LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.

The Lakeland Medical Office Association invites you to attend our November luncheon and seminar. 

Title:    Human Trafficking

   Upon completion of the training, participants will be able to:

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November 5, 2024

PriorityActions November 1, 2024 Issue

PRIORITYACTIONS issue includes: *2025 Product Guide for Providers is now available * a look at our 2025 Disease Burden Management Program * Commercial, individual and Medicare formulary changes coming Jan. 1, 2025 * Mail order pharmacy supply change impacting new starts effective Dec. 1, 2024 * Commercial and individual formulary changes effective Jan. 1, 2025  
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October 14, 2024

PriorityActions October 10, 2024 Issue

In this October 10, 2024 issue :
* Reminder: You must complete our 15-minute, CMS-required D-SNP Model of Care training
*Reminder: You must complete our 15-minute, CMS-required D-SNP Model of Care training
*Void claims now appear on remittance advice with original claims
*Reminder: Informal claim reviews are required before appeals
*Southwest Michigan providers: Medicaid rebid changes do NOT impact Medicare
*Southwest Michigan providers: Do not turn away any Priority Health members based on their plan type. Please continue to see new and existing Priority Health patients with any plan you participate with, checking their eligibility before you see them just as you did before.
*Register now to learn about our 2025 DBM program on Oct. 29 
*Incentive programs

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October 7, 2024

Lakeland Care Network 2024 Coffee with MIOSHA Invitation

MIOSHA and Lakeland Care Network, in collaboration with Corewell Health Lakeland invite you to share a cup of coffee and learn about the importance of workplace safety and health.

‘Coffee with MIOSHA’ events provide an informal opportunity for employers and employees to meet with MIOSHA representatives (consultative and enforcement) to ask questions, obtain information on program services and resources, learn about the MIOSHA Training Institute (MTI) opportunities, and establish rapport.

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October 1, 2024

Lakeland Care Network Annual Payor Conference - October 16, 2024

The Lakeland Medical Office Association invites you 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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