Effective October 1, 2025, Humana is transitioning from a regionally-based UM model to a centralized national structure for inpatient and post-acute Medicare services. Centralizing UM operations will streamline processes and enhance consistency in supporting providers across all markets.
The Corewell Health Flu Shot Clinic poster is available if you'd like to post this in your offices or give to friends, etc.
Corewell Health, in collaboration with Lakeland Care Network, will offer Community Flu Clinics in Southwest Michigan beginning in September 2025. Flu vaccines are available for adults at drive-thru and walk-in clinics, with no appointment necessary.
The Lakeland Medical Office Association's mission is to bring quality educational programming to our medical office community in Michigan's Great Southwest. Please take a few minutes to complete a short 3-minute survey as we try to continue to listen to your needs.
Click on 'READ MORE' below to take the survey.
Watervliet hospital is proud to expand their heart care services, now offering services five days per week in addition to cardiology testing for patients who previously had to travel to Niles and St. Joseph.
CASSOPOLIS, Mich.– Cass Family Clinic held a ribbon-cutting event on Tuesday, July 15, for its new Mobile Health Clinic. The event took place at Cass Family Clinic’s Cassopolis location, 261 M-62 North. The year-round Mobile Health Clinic will offer health and wellness exams, sports physicals, substance use disorder (SUD) behavioral therapy, acute musculoskeletal issues, blood pressure checks, influenza vaccinations, patient education, and other medical resources.
This is a reminder that the FMCSA's National Registry II (NRCME II) Final Rule took effect on June 23, 2025. As a Certified Medical Examiner, your role is critical in ensuring commercial drivers remain in compliance and avoid unnecessary disruptions to their driving privileges. Beginning 6/23/25, all exam results for CDL and CLP applicants/holders must be submitted electronically through the National Registry by midnight of the next calendar day following the examination.
Beginning July 1, Stelara® IV will be removed from coverage under the medical benefit for Priority Health's commercial and individual members. This change will only impact members who aren’t currently being treated with Stelara IV. Members already approved for Stelara IV under the medical benefit will remain covered.
Priority Health recently made the following update to their 2025 PCP Incentive Program (PIP) Manual:
Care Management codes (pg. 20-21) - The code table has been corrected to reflect that Priority doesn’t pay for 99490 for commercial plans.
Effective July 28, 2025, claims submitted with the CS modifier will be denied. You’ll see denial code “E1J – Modifier used inappropriately” in prism.
Lakeland Care has learned from several of our physicians that Meridian sent a letter directly to them asking to amend their contract to include two new products including Meridian Medicare Advantage plans and another Dual-Eligible plan. This is time sensitive as Meridian has made it so you will automatically be participating into these two new products in 30 days from the date of your letter.
Effective 5/1/25, the Andrews University employee plan (not the student plan) is using a TPA through Priority Health called HMA. These patients should be considered IN-network with Lakeland Care.
Lakeland Care network has had several contracts with United Healthcare for 15 years. We have a Commercial contract, a Medicaid contract with United's Community Plan, a Medicare contract for Veterans Affairs Community Care Network, and a Duals contract for their UHC Dual Complete Medicare Advantage. However, through all these contracts, mental health has been very difficult for UHC to administer correctly. Therefore, Lakeland Care network providers who wish to see United Healthcare patients for any of their products need to contract directly with Optum.
Effective June 2, 2025, Priority Health will NOT review post-claim appeals for medical necessity when a denied authorization is on file for the following authorization types, for all lines of business:
• Outpatient, home health & DME
• Elective inpatient
• Behavioral health
Note: This change doesn’t apply to inpatient acute / urgent / emergent or post-acute authorizations.
This applies when you’ve requested an authorization, received a denial for medical necessity and performed the service or procedure. Services / procedures performed with a denied authorization become provider liability. This change is in alignment with industry standards.
Beginning June 2, 2025, Priority Health will use 2025 InterQual® criteria to make medical necessity determinations on prior authorization requests to ensure their members are getting the right care, at the right place and at the right time. The types of authorizations that are affected are below.
Lakeland Care Network together with Corewell Health Lakeland have pharmacists available to serve your patients. Our clinical pharmacists can help with medication reviews, adjustments, and savings all while reducing potential side effects. We manage a variety of conditions from diabetes and high blood pressure to COPD, osteoporosis and others. Call us to schedule or ask your physician for a referral.
United Healthcare provides updates on their Specialty Medical Injectable Drug Program and their Prescription Drug List.
Corewell Health Lakeland's diabetes and nutrition team is ready to help you take control and manage your health. We offer everything from diabetes education and nutrition guidance, to group classes and personalized health plans. Our education team offers our services in St. Joseph, Niles, and Watervliet.
On April 16, 2025 the Lakeland Medical Office Association invites you to join us for lunch and a presentation on "Disclosure of Unanticipated Outcomes." Details are below.
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 March luncheon and seminar presented by WPS**