Providers

To better serve our pediatric members, Aetna now offers an annual incentive to successfully enrolled VFC providers servicing children ages 19 and under as part of our Pay-for-Quality (P4Q) Program

-August 2024 medical policy updates: Benign Prostatic Hyperplasia (BPH) Treatments, Infectious Disease Molecular Panels, Infectious Disease Molecular Panels
-Moving to InterQual® criteria
-Added prior authorization requirement: Varicose Vein Treatment
-Updated payable units: Breast Related Procedures
-Updated prior authorization guidance: Genetics: Counseling, Testing, Screening
-Additional medical policy updates: Policy updates effective Sept. 1, 2024
-Authorizations:Start submitting cardiac & MSK authorization requests to TurningPoint today
-New reports to help close osteoporosis care gaps
-OMW gap closure
-Learn more about our fall quality initiatives
-

Priority Health has shared a document for offices to help navigate their questions and how to successfully resolve any issues.

Please share with your fellow office teammates!

A Special Edition Update from McLaren Health Plan:

As we continue to navigate the impact to our operations due to the cyber-attack, we are making progress restoring our systems and services. Below is an update on key items:

Customer Service
The McLaren Health Plan Member and Provider Call Center is operational, although they may not have access to all systems, they can provide assistance and direction.

McLaren Connect Provider Portal

*Medicaid rebid impacts on providers in Northern and Southwest Michigan
*Starting September 23, groups must have a pSA to affiliate prism users
*Reminder: You must complete our 15-minute CMS-required D-SNP Model of Care training
*APCD replacement files will be delivered via SFTP starting August 15
*Resources & trainings for TurningPoint authorizations programs
*Provider trainings for EviCore’s radiation oncology authorizations program
*Finalizing 2024 InterQual® criteria transition
*New coding policies posted to the Provider Manual

UnitedHealthcare Selected to Serve Medicaid Members in Michigan Through the Comprehensive Health Care Program

Eligible adults and children will have access to UnitedHealthcare Medicaid services and benefits in six regions

The Michigan Department of Health and Human Services (MDHHS) has selected UnitedHealthcare Community Plan of Michigan as one of the nine managed care organizations to administer the Comprehensive Health Care Program (CHCP). 

What do these drugs treat?

Ogivri and Ontruzant are both biosimilars for Herceptin® and are used to treat breast cancer, gastric cancer and esophagogastric cancer.

How will this impact you?

Ogivri: For our commercial group, individual and Medicare Advantage members, Ogivri will be covered under the medical benefit with no prior authorization requirements effective August 1.

Ontruzant:

For commercial group and individual members, Ontruzant will remain a non-covered drug. If you’d like to seek treatment with Ontruzant for your patients, prior authorization is required.

For Medicare Advantage members, Ontruzant will remain a covered drug with prior authorization requirements, which include trials of both Ogivri and Trazimera.

* Get our Q3 Physician and practice news digest and our Q3 Medicare/Medicaid Quality newsletter
*Take action today before your staff loses access to prism
*How do I complete the pSA renewal process?
* Reminder: Unique NPI required for rehab groups to credential BH providers
* Coding policies going into effect September 23, 2024
* Do your Medicare patients qualify for Extra Help?
* Register now to learn about our Q4 Medicare/Medicaid Quality campaigns on August 29, 2024

Aetna Better Health has sent paper copies to offices and has provided LCN this electronic copy of the Spring 2024 Provider Newsletter.

July 2024 UHC Updates:
*New prior authorization requirements for Continuous Glucose Monitors
*Updates to oncology and hematology prior authorization codes for many plans
*Michigan: Prior authorization updates for provider administered medications
*July 2024 Preferred Lab Network list is now available
*Annual federal audit of commercial plans
*Add your merchant ID in My Practice Profile
*Complete special needs plan MOC training by Dec. 31
*Digital Solutions
*Policy and protocol updates See the updates

Priority Health - PriorityActions for providers update July 11, 2024
*Resource to address GLP-1 shortages and support patient medication adherence
*July VOA roundup: watch new Modules and register for upcoming webinars
*Provider trainings for TurningPoint authorizations programs
*Reminder: Attest to your providers’ PCMH designations in PRA
*Prism inquiry turnaround times and when to reach out to our team

*Get free vaccines for your eligible patients through the Vaccines for Children Program
*Register now to learn about our 2025 PCP Incentive Program on July 11, 2024
*Reminder: you must refer members to in-network providers, including labs

Get free vaccines for your eligible patients through the Vaccines for Children Program!
What’s the Vaccines for Children (VFC) Program?

The VFC program is a federally funded program offered through the Michigan Department of Health and Human Services (MDHHS) that provides you with vaccines, at no cost, for your Medicaid-eligible patients ages 0 through 18. VFC program providers get free vaccines for eligible patients and are reimbursed for vaccine administration. 

Want to know more? 

Barry-Eaton District Health Department (BEDHD) and Michigan Department of Health and Human Services are investigating 3 cases of Legionnaires’ disease (LD) associated with Bay Pointe Inn located in Barry County. The cases reported travel to Bay Pointe Inn (11456 Marsh Rd, Shelbyville, MI 49344) between March 2024 and June 2024.

Meridian discovered an internal issue this morning, June 12, 2024. There were several claims denied for CHAMPs eligibility. Offices likely would have seen those denials as F6 or F7. Meridian was able to stop the majority of the claims prior to going out, but unfortunately some had already gone out denied. The problem was due to a broken internal file interface. 

PriorityActions June 6, 2024 Issue. Please visit the Priority Health provider site for full details and updates to the following:
Authorizations, new radiation oncology authorizations programs, incentive programs, pharmacy, requirements and responsibilities, billing and payments,and training opportunities.

New MSK authorizations program will launch September 2024

In addition to cardiac managed care, we’re also partnering with TurningPoint on a new authorizations program for musculoskeletal (MSK) procedures, both slated to launch September 2024.

These programs are designed to facilitate provider-to-provider collaboration on each member’s care plan, with the overall goal to optimize health outcomes and work more closely with you, our provider partners, on evidence-based, value-driven care.

Updates to Emergency Department Facility Evaluation and Management Coding Policy effective July 1, 2024.

Highlighted in this issue are: Incentive programs, Updated 2024 HEDIS guidelines, Updated 2024 PIP manual, May 2024 Medical Policy Updates, Mandatory pSA Renewal process begins June 1, 2024, Reminder to follow ICD-10 guidelines, and Virtual Office Advisory Training on June 13

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.