February 01, 2025 Monthly Overview
UHC Network News is published twice a month. See updates below.
Policy and protocol updates
Medical policy updates
Medical policy updates for February 2025 for the following plans: Medicare, Medicaid, Exchanges and commercial.
* 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
* 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
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:
Please review the updated attachments sent via fax blast or USPS mail to all providers.
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
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
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
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:
Thank you all so much for joining us at this year's Payor Conference. We are always so thrilled to be able to spend some time together. As promised, attached are the slide decks from the payors who were present.
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:
Priority Health has provided a few documents that will help offices navigate their processes. Attached are two information sheets on PRISM and one information sheet on how to get office questions answered while navigating the Priority Health system
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
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.
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.
In the September 26th issue, Priority Health discusses the following topics:
*Register now to learn about our 2025 product updates on Oct. 17
*We’ve added exclusion criteria to our SUPD provider tipsheet
*Have you visited our Quality Improvement page?
*Reminder: groups must now have a pSA to affiliate prism users
*Helping alleviate fall risks for your Medicare patients
*Get our 2024 member outreach calendar
*Prescription Drug Take Back Day coming Oct. 26
*Encourage your patients to try Teladoc Health Mental Health
Attached you will find this month's update to provider offices that will be faxed to offices. Please be on the look out for them to arrive in your offices.
There are a number of attachments below that discuss HIV as well as the most recent Provider Bulletin No 220.
Provider Bulletin 219 discusses what offices need to do in order to transfer EFT remittance advice services to ECHO Health.
An estimated 38,000 Americans are newly diagnosed with HIV each year, with a disproportionate amount of new diagnoses taking place within marginalized and low-income communities. We want to partner with you to help reduce HIV diagnoses and increase suppression rates across the state of Michigan and our Medicaid population.
INCENTIVES-
Updated 2024 PIP Manual available