Providers

Review this important information to help you work with Priority Health and care for members.

Blue Care Network mailed additional letters in November 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics, or PGx, test as part of BCN’s new Blue Cross Personalized MedicineSM program.

One or more of your physicians is included in this additional mailing. Attached is a generic copy of the letter mailed. In addition, each physician received a list of his or her patients being offered the test, a Quick Start Guide and a copy of the member communication (also attached).

We’ve been recognized as a top performer by the National Committee for Quality Assurance (NCQA)

The National Committee for Quality Assurance (NCQA) has given our Medicare HMO/POS plans 4.5 stars (out of 5), making them the top-rated Medicare plans in Michigan and among the highest-rated plans in the nation.

NCQA also recognized our commercial and Medicaid plans:

Thank you to those of you who could join us on the evening of October 25 for the BCN/BCNA/MAPPO Gain Share Contract and Program updates for 2024. We know some of you had conflicts and were not able to attend, so we recorded the meeting. Due to the size of the file, we are pushing the recording of that meeting through your EDIFECS accounts tomorrow. It sometimes takes several hours for those to go through, so I’d give it until Wednesday to retrieve it.   

Review this important information to help you work with Priority Health and care for members.

Blue Care Network mailed additional letters in October 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics, or PGx, test as part of BCN’s new Blue Cross Personalized MedicineSM program.

One or more of your physicians is included in this additional mailing. Attached is a generic copy of the letter mailed. In addition, each physician received a list of his or her patients being offered the test, a Quick Start Guide and a copy of the member communication (also attached).

Priority Health has updated our observation stays policy to align with industry standards. Observation stays will now be reimbursed up to a maximum of 72 hours, across all plan types. Stays exceeding 72 hours will not be reimbursed.

This change aligns with CMS policy which defines observation stays exceeding 72 hours as medically unlikely. It will also support our shared goal of ensuring our members, your patients, get the right care in the right setting.

Beginning Jan. 1, 2024, Meijer Specialty Pharmacy has chosen to no longer participate in our specialty pharmacy network for commercial and individual members. This change only impacts drugs covered under the pharmacy benefit. Drugs covered under the medical benefit aren’t affected.

Medicare and Medicaid members can continue to use Meijer Specialty and retail pharmacies for all their prescriptions. All members may continue to use Meijer’s retail pharmacies for their prescriptions that don’t require a fill at a network specialty pharmacy.

Beginning Oct. 19, you’ll receive biweekly PriorityActions emails that will include important and actionable information to help you work with us and care for our members, your patients.

To maintain our commitment to providing our members with the most effective therapies at the lowest possible cost, Humira coverage will end for our commercial group and individual members on Dec. 31, 2023. This includes both new-start and existing prescriptions.

Humira will remain on the Medicare formulary, with prior authorization requirements, through 2024.

Effective Oct. 1, 2023, coverage for the Humira biosimilars, Hadlima and Adalimumab-adaz (manufactured by Sandoz) was added to our Medicare, commercial and individual member formularies.

We know how much hard work you put into population health and chronic condition management in your practices. We want to make capturing important information about your patients easier and more efficient so you can focus your time on what matters most – your patients, our members.

The Lakeland Medical Office Association invites you and/or your staff 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.

Blue Care Network mailed additional letters in September 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics, or PGx, test as part of BCN’s new Blue Cross Personalized MedicineSM program.

One or more of your physicians is included in this additional mailing. Attached is a generic copy of the letter mailed. In addition, each physician received a list of his or her patients being offered the test, a Quick Start Guide and a copy of the member communication (also attached).

Priority Health has provided an update to a popular handout with highlights of typical office questions that Priority Health receives. Please feel free to print and share with your office teammates!

Please see the attachment provided below for all of the details. 

The Centers for Disease Control and Prevention recommends a yearly flu vaccine for everyone ages six months and older as the best protection from this serious illness. Lakeland Care Network (Lakeland Care), in collaboration with Corewell Health, will offer drive-through community flu shots on the following dates:

As healthcare continues to transition into the digital space, we’re adapting our data strategy to follow suit. 

We announced in June that Patient Profile and the PIP_70 report will be retired with the close of the 2023 PIP performance year. Beginning with the 2024 performance year, we’ll accept only the following supplemental data sources for quality gap closure: 

Blue Cross Blue Shield of Michigan has experienced a work stoppage with our UAW-represented workforce. While we work to reach a labor agreement, please be assured that we will continue to process and pay your healthcare claims.

Your provider offices should continue to submit claims as normal. We will process and reimburse healthcare practitioners throughout the work stoppage. All of our benefits and billing requirements remain the same.

As of July 1, 2023, the State of Michigan is now covering diabetes prevention program (DPP) participation for Medicaid enrollees statewide. This means that more than 18,000 eligible Priority Health Medicaid members may now participate in this important, free lifestyle change program.

A summary of the September news and talking points from UnitedHealthcare.

Our Medical Advisory Committee (MAC), comprised of network physicians contracted with Priority Health, met this month and approved a series of medical policy updates. All updates are outlined in our policy updates webpage; below is a new policy we want to draw your attention to.