BCBSM/BCN is offering a FREE learning opportunity for your physician offices in September at a movie theater near you. They are hoping that you’ll join them and encourage your physicians and their office managers, patient experience leaders, billers and coders to attend.
TRUTHS, TIPS AND TACTICS
About patient experiences that will help your patient:
Attached are the informational handouts from Meridian for August:
At times, a PCP office has a UHC - CP member who requests to change their primary care provider (PCP) .
This attached form will expedite the change request for the member. Instructions are listed on this form.
Lakeland Care has several payors who are a part of our Cofinity contract. These payors are listed below:
A friendly reminder from UHC:
Attached is a brief summary of UHC's electronic data education which includes information and resources for electronic transactions.
Here is this month's educational handouts from Meridian:
Aetna Better Health has recently provided the following informaiton:
Please review the information below regarding EVICORE authorizations and appeal guidelines.
Medical Prior Authorizations:
Note: If a claim denies not authorized, providers must request an authorization before submitting a provider appeal. If the retro authorization request is denied, a provider appeal can be submitted to the health plan.
High Tech Radiology Authorizations
Attached is an example of the Priority Health insurance card for the Bronson Narrow Network to use as a reference.
Below is a link to the Priority Health website where there are examples of all of Priority Health cards for all of their products.
Aetna Better Health of Michigan will be updating on or before August 1, 2019 their Provider Manual and Website to provide clearer understanding and instruction to providers related to the various Dispute / Appeal / Grievance processes that are available. These updates apply to BOTH our MI HealthLink Duals product & our Medicaid product.
Please see attached flyer for more detailed information.
Aetna Better Health of Michigan occasionally updates codes to change prior authorization (PA) requirements. Effective September 1, 2019, Aetna Better Health of Michigan, for all lines of business, will not require prior authorization for some CPT/HCPCS codes before services are rendered. Please note the allowable units for each service below.
For the complete list and details, see the attachement.
Meridian has provided these informational handouts for refernece:
Summary of the Incident:
Attached is an updated version of the ASR provider manual that has been updated, and will be effective as of July 1, 2019.
Key components of these changes address:
Effective August 1, 2019, Meridian is implementing updates to Meridian Medical Policy B. 05 Readmission Review. This policy outlines Meridian’s processes of reviewing, adjudicating, and adjusting claims payments for inpatient admissions that are deemed to be potentially preventable readmissions. This policy is in alignment with Michigan Department of Health and Human Services’ Medicaid Provider Manual Readmission, Section 9.2. Meridian Medical Policy B. 05 Readmission Review policy is available on the Meridian website under Training & Education Resources.
Meridian has provided these educational handouts for this month:
There has been some confusion on the proper forms to send into Meridian for Prior Authorizations. At times, the form is sent to the incorrect fax number, which results in delays of getting the needed authorization approvals in a timely manner. The Meridian Team must then route the form to the correct intended department, and this causes unneeded delay for the patient.
MeridianComplete (Medicare-Medicaid Plan) will be ending their relationship with ConncertoHealth (Concerto), also known as MeridianCare Continuim on May 31, 2019. A new vendor, H3 Management Services, will begin to provide services as of June 1, 2019. There will be no immediate authorization process changes.
For more details, please see attached document.
Humana has added a number of Availiaty webinars which can be viewed thru the Availity.com Provider Portal
Hosted By: Jason L. Johnson, Humana eBusiness Consultant
Each person in your organization must register separately.
The webinar lasts approximately 50-55 minutes.
Webinar Agenda
• Administrator Dashboard
• Payer Spaces
• Authorization & Referrals
• Eligibility & Benefits
• Claims Management
• Code Edit Simulator
• Medical Records Management
As you know, Cofinity is migrating to a new claims repricing platform that requires a change in the traditional Cofinity claim submission workflow. The new platform will streamline their administrative processes and help them improve the service they provide to you and payer clients.
How this impacts you:
Measles can be dangerous for babies and young children.
Symptoms include:
The MMR (measles- mumps-rubella) vaccine can provide children protection.
For additional informaiton, please visit these sites:
UPDATE ON COPAYS:
Meridian has provided these informational monthly handouts:
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey includes a wide range of questions, some of which are tied to care coordination. This very important topic was identified by the Institute of Medicine (IOM) as one of the national priorities for action to improve quality and make care safe, effective, patient centered, timely, efficient and equitable.1
Meridian has provided informational handouts on the following topics:
In addition, there are informational sheets on:
Now that Lakeland employees have moved from ASR to Priority Health, here's some helpful information for your office to know for your patients who are Lakeland plan members. The attached update reviews correct copay amounts for Primary and Specialty Care, Patient Costs, Covered Preventative Services, Referrals and Prior Authorizations.
As you know, Cofinity is migrating to a new claims repricing platform that requires a change in the traditional Cofinity claim submission workflow. The new platform will streamline their administrative processes and help improve the service they provide to you and their payer clients.
How this impacts you
The Lakeland Care Network has added two additional Employer-Specific payors to our panel.
Effective February 1, 2019, all Lakeland Care Network providers and offices participate with Prairie States Enterprises through our Cofinity contract. You are participating with this payor ONLY for the HighGrade Materials employer group.
The Lakeland Medical Office Association invites you to attend our March luncheon and seminar. This month’s seminar is two presentations in one and will include role-playing scenarios for clarity at the end.
Dr. Birris will be speaking first on how medical stressors affect how patients react to medical staff. Then, Norma Tirado will be talking about how we react to those stressed patients and why - what triggers our bad reactions.
Meridian has provided some informational handouts on the following topics:
Lakeland Care Network Employer Services is offering you a chance to hear more about how to navigate the new law while maintaining a safe work environment at our upcoming breakfast forum. Hurry, registration ends Friday, February 15, 2019.
Will Marijuana Legalization Change Workplace Drug Policies?
Does the New Law Require Employers to Allow Use at Work?
What Does it Mean for Testing?
The Lakeland Medical Office Association invites you to attend our February luncheon and seminar.
Program: ICD 10 and Coding Updates
Please remember that all labs requested for Lakeland associates, need to go to Lakeland laboratories, not Quest.
Although the plan administrator changed from ASR to Priority Health for the Lakeland employees on 1/1/19, the requirment for Lakeland covered plan members' labs stays the same - they must be sent to Lakeland for in-network consideration.
As Southwest Michigan Behavioral Health (SWMBH) continues to move forward in reducing paper and finding more efficient and cost effective ways to reduce healthcare administrative costs we are making changes to allowable claims submission methods for providers.
Effective October 1, 2018, SWMBH will no longer accept paper claims from its provider network. Claims will be returned to the provider. There are now multiple ways for providers to submit claims to SWMBH without the need for paper forms. Claims may be submitted in any of the following ways:
The Lakeland Care Network has added an additional Medicare contract to its panel. Effective 1/1/19, all Lakeland Care Network providers and offices participate with Blue Care Network's Medicare Advantage HMO plan. This new contract will join Lakeland Care's two other existing Medicare Advantage contracts that are held with Humana and Priority Health. As this is a new contract, membership numbers will be low, so you may not see very many patients come in with this new coverage this year.
With the change from using ASR as their medical benefit plan administrator to Priority Health, Spectrum Health Lakeland wishes to provide some clarity on their associates' co-pays for 2019.
The co-pays for Lakeland associates remains $30 for PCP and Specialty visits.
Effective on January 1, 2019, Gaishin Manufacturing and Supreme Casting have changed their insurance coverage from Ameraplan to ClaimChoice.
At this time, please continue to send claims to Cofinity until further notice of changes.
LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.
The Lakeland Medical Office Association invites you to attend our January luncheon and seminar.
Program: Legislative Update of Current Political Events and their Effect on Medical Practices
Join us for Josh Richmond’s presentation on Michigan’s current political events and policy.
Topics will include:
