May 21, 2024
BCBS and BCN - Alignment of Newsletters
Blue Cross Blue Shield of Michigan and Blue Care Network will be announcing the alignment of Blue Cross physician organizations and BCN medical care groups in provider newsletters.
Blue Cross Blue Shield of Michigan and Blue Care Network will be announcing the alignment of Blue Cross physician organizations and BCN medical care groups in provider newsletters.
The latest issue of PriorityActions for May 9, 2024 include:
*Change Healthcare outage update: Electronic RAs resumed through Change Healthcare and Optum clearinghouses; all services should be restored
*We’re transitioning to 2024 InterQual® criteria starting July 15
*We’re no longer allowing providers to be enrolled under multiple ACN contracts with the same NPI, TIN and address
*We’re requesting medical records for an MDHHS audit
*We’re reprocessing incorrectly rejected Tdap vaccine claims
Meridian has partnered with Evolent (formerly New Century Health) to implement a new prior authorization program. Evolent is a comprehensive Cardiology Quality Management Company. This program is intended to help providers easily and effectively deliver quality patient care.
Effective June 1, 2024, invasive cardiology procedures and services will require prior authorization through Evolent rendered in a physician’s office, outpatient hospital, ambulatory, or inpatient setting (planned professional services only) will require prior authorization through Evolent.
The latest issue of PriorityActions for April 25, 2024 include:
-ID.me identity verification now required for new prism users
-Providers may need to resubmit incorrectly denied COVID vaccine claims for payment
-Hearing aid providers: Invoice submission for Medicaid members is no longer necessary
-PriceMyMeds launching on April 25 to increase prescription drug affordability
-Formulary changes for commercial group and individual members coming July 1
-Aligning with Cognizant engine changes as they’re released
-Helping you get 2024 medication adherence reports into the right hands
The Lakeland Medical Office Association invites you to attend our May luncheon and seminar.
Title: Wellbeing in the Medical Office
Uncover the science behind stress-reducing strategies.
Discover what is needed for professional fulfillment.
Learn how to foster a culture of well-being in your workplace.
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.