News

Effective April 5, 2021, you will be directed to GuidingCare to request musculoskeletal authorizations, instead of eviCore.  Our portal will direct you automatically to GuidingCare as you start to enter the authorization details.

There are no new authorizations or other changes currently. You’ll continue to use eviCore for high-tech imaging and genetic testing authorizations. Retro authorizations for musculoskeletal services will continue to be processed by eviCore.  

On Oct. 22, 2020, Governor Whitmer signed two bills (Public Act No. 234 and No. 235) into law that forbid out-of-network PARE providers from sending surprise bills to patients. Surprise billing, or balance billing, has never been allowed for our participating providers.

Aetna  Medicare member IDs are changing from the alpha numeric mix of MEB or MED**** to 12 digit numbers starting with ‘10’.  See below on the info/details and ID card examples

Member ID numbers are changing

• Member ID numbers are 12 digits and start with ‘10’
• Members will be mailed new ID cards

If a claim for a 2021 date of service is submitted using an older 2020 HMO member ID, claims logic is in place to evaluate the member ID and the DOS and redirect the claim to the appropriate claims platform.

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

Please read the attached newsletter for February 2021 from UHC for all of the latest details.

A preview:  To ease the administrative burden you may be experiencing in submitting COVID-19 vaccine administration claims for Medicare beneficiaries, UnitedHealthcare has made it easier for you to find a member’s Medicare ID number. We also have a tool to help members find state and county health department resources on FDA-authorized vaccines, as well as materials you can use to encourage your patients to wear masks – a critical step in reducing the transmission of COVID-19.

 From Humana:

As we continue to monitor the status of COVID-19 cases and review procedure data in the 22 states listed below, we are implementing changes to authorization requirements.

Humana is reinstating authorization requirements for Medicare Advantage and commercial members for skilled nursing facilities (SNFs) for dates of service on or after March 1, 2021, in these states:

 Statewide reinstatements

o Arkansas

o Colorado

o Delaware

o Idaho

o Indiana

o Kansas

o Kentucky

Information to sign up for Centine (Meridian Health) Monthly Provider Updates can be found by registering at:  mhplan.com  

Currently, there also are Complete and Ambetter independent websites that providers could register for access to those websites and look for any current updates,

To access Ambetter website:   ambettermeridian.com 

From Humana --

An important message regarding  Humana’s COVID-19 response:  ADMINISTRATIVE UPDATE   Jan. 20, 2021

Like you, we are concerned with the unprecedented surge of COVID-19 cases in Arkansas, Colorado, Delaware, Idaho,

Indiana, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma,

Pennsylvania, Texas, Utah, Virginia and West Virginia. We strive to understand the unique challenges different states face

and determine how we can help.

Stay informed about COVID-19

Latest COVID-19 news from UnitedHealthcare – Updates to temporary COVID-19 treatment and prior authorization provisions, reminders on vaccine administration reimbursement

Thank you for all the work you continue to do to care for your patients during this time. We are sharing the following updates to help you deliver care and be reimbursed for the services you provide:

Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.

Humana is providing these documents as a resource for practices:

• Humana Claim payment Inquiry Resolution Guide
• Humana Tools and Resources for Physicians and Healthcare providers
• Availity Overpayment Tool: How to Access the Recorded Training Session

Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.

What you need to know

Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.

Examples of fraudulent requests:

UnitedHealthcare is extending the temporary suspension of select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide through Jan. 31, 2021. The temporary suspensions are effective from Dec. 18, 2020 through Jan. 31, 2021. (They were previously set to end on Jan. 8, 2021.)

Please read the attachment for the latest news from Priority Health!

In addition from Priority Health:

The 2021 PCP Incentive Program (PIP) manual is finalized and available for download. Visit 2021 PCP Incentive Program Manual (priorityhealth.com) to view.

Overview of 2021 finalized PIP manual

2021 new measures

Since the COVID-19 pandemic began, CIGNA has delivered timely accommodations to providers and customers, and ensured that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.

Please read the attachment for details on vaccines, treatments and extended coverage accommodations.

To remain in compliance with Medicaid billing requirements, on December 14, we’re moving to up-front claims rejections that have the missing or incorrect information listed below. Previously these were warnings.

What’s changing

The new upfront rejections included:

To continue to support you and our members as COVID-19 cases rise in our communities, we’re extending many temporary changes into 2021. Get the complete list of temporary changes and their expiration dates.

Humana has provided the first FAQ related to the COVID vaccine, and it will be updated weekly as new information is available.