Providers

Dear BCN Medical Care Group Business Administrator, Blue Cross Physician Organization Administrator and Blue Cross Risk Based Contracted Entity Administrator:

Blue Cross Blue Shield of Michigan and Blue Care Network’s 2021 BCN Advantage℠ and Medicare Advantage PPO settlements will be delayed due to a delay in Blue Cross receiving the final revenue file from the Centers for Medicare & Medicaid Services. 

Please see that attached November 2022 Network News bulletin updates and the UHCCP P4P updates flyer.

We have recently created a new “known claim issues” posted on our MIMeridian website, it provides all the current system issues and that will be updated.

The Lakeland Medical Office Association invites you to attend our November luncheon and seminar presented by Jim Leach.

We’d like to invite you, your primary care physicians, pharmacists and support staff to an upcoming webinar discussing our new end-to-end precision medicine pharmacogenomics (PGx) program called Blue Cross Personalized Medicine℠.

It’s been our priority for more than 25 years to reward the high-quality care you provide our members through our PCP Incentive Program (PIP). We’re excited to usher in opportunities for you to earn incentive payments more frequently throughout the year through our 2023 PIP program.

A whole new PIP

We’ve redesigned and rebuilt the PIP program from top to bottom for 2023. Starting in January, you’ll:

Presentations by Lakeland payor partners

The Humana Claim Payment Resolution Handbook is attached.

In order to support the transition from fee for service to value-based care, we will be introducing a 1.5% allocation from commercial PPO professional fees to fund the commercial PPO Blueprint provider risk arrangements. 

On Oct. 12, 2022, Blue Cross Blue Shield of Michigan and Blue Care Network posted the attached provider alert, ordering transfers from noncontracted (or nonparticipating) ambulance services costs members money.

As a reminder, Cigna members who are under different health plans are covered by Priority Heath through our Strategic Alliance with Cigna. This means that Cigna members traveling in Michigan who have health plans covered under a Cigna Strategic Alliance can see our in-network PPO providers.

October monthly overview

https://www.uhcprovider.com/en/resource-library/news/2022/policy-protoc…

Why Implicit Bias training?  Effective June 1, 2022, LARA announced the adoption of new rules that require Implicit Bias Training for all medical licenses and renewals. 

All renewing licensees are required to complete 1 hour of this training for each year of their license cycle. The training is required to be interactive.

Please see the attached FAQ sheet for details.

Provided to our office from Aetna: 

Sometimes there is a lot of information regarding payors that is confusing to our offices on what is or is not participating.

Aetna Signature Administrator (ASA)  are PAR with Lakeland Care Network. 

Please read the attachment for details regarding ASA Payers and  TPA information that will be helpful to navigate these plan for offices and for providers alike. 

There are three websites offered by Ambetter / Meridian Health as resources to providers and their offices:

Medicaid – Mhplan.com

Complete -  https://corp.mhplan.com/en/provider/michigan/complete/

Ambetter – ambettermeridian.com

MDHHS is hosting a series of CHAMPS 101 Webinars over the next several weeks for interested providers and billers.  MI Operations & Regulatory Affairs wanted to share in the event that we’d like to share with any of our provider community.

Medicaid claims that do not meet the Michigan Department of Health and Human Services (MDHHS) billing requirements are being rejected as of Jan. 1, 2020.

Updated Medicaid Managed Care Plan Provider Enrollment Timeline

August 29, 2018: Health care providers that serve Medicaid beneficiaries are facing an upcoming enrollment deadline that is necessary for them to continue to receive payments from Medicaid. 

While the Michigan Department of Health and Human Services (MDHHS) has revised the timeline to give providers more time to enroll, the department is urging providers to complete the screening and enrollment process as soon as possible.

CHAMPS Enrollment Enforcement

CHAMPS is Michigan Medicaid’s Provider Enrollment System

All Lakeland Care providers are now required to access CHAMPS to register in the Michigan Medicaid program. Registering in the Michigan Medicaid program does not require you to be a Medicaid FFS provider. The State of Michigan is requiring this change in accordance with the 21st Century Cures Act.