Please review the Aetna Better Health attachments sent via fax blast or USPS mail to all providers. Please share with your staff.
Provider Letter: Prior Authorization change - Codes now requiring prior authorizations effective 2.15.2025
Provider Letter: Aetna Better Health new physical address change only– effective 1.15.2025
2 Towne Square Suite #275
Southfield, MI 48034
New and updated billing policies are now available
We publish billing policies to offer transparency and help you:
Please read the following UHC Network News mid February update to catch up on the latest UHC changes.
* Prior authorization changes
* UHC Provider Portal updates
* Miscellaneous news
* Support Black History Month through health equity
* Electronic submission required for claim reconsiderations
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.
* 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
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 February luncheon and seminar.
* 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
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