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.
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.