Latest news

BCBSM/BCN - Truths, Tips and Tactics about Patient Experiences Seminars

August 29, 2019

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:

Meridian - Monthly Informational Handouts

August 29, 2019

Attached are the informational handouts from Meridian for August:

  • August Monthly Provider Update
  • Childhood and Adolescent Immunizations
  • Care for Older Adults
  • DMARD Therapy for Rheumatoid Arthritis
  • Statin Therapy and Adherence

UHC - Community Plan Change Request Form for PCP

August 28, 2019

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.

Cofinity - August update to claims submissions changes

August 28, 2019

Lakeland Care has several payors who are a part of our Cofinity contract.  These payors are listed below:

  • Group Marketing
  • Liberty Union
  • Physicians Health Plan (PHP of Mid Michigan)
  • Secure One
  • Trustmark - Starmark, Nippon lIfe, CoreSource, NGS CoreSource, FMH
  • Claim Choice
  • Group Resources
  • Healthgram
  • Prairie States
  • NOTE:  the only payor that at this time has not completed the migration is US Health & Life 

 

UHC - Self Service Resources

August 1, 2019

Attached is a brief summary of UHC's electronic data education  which includes information and resources for electronic transactions.

 

Meridian - Monthly Informational Handouts

July 24, 2019

Here is this month's educational handouts from Meridian:

  • Healthy Michigan Plan - Health Risk Assessment
  • Meridian Health Healthy Michigan Plan Informational Handout
  • MeridianCare (Medicare) Brand Transition information

Aetna Better Health Premier - EVICORE Authorization and Appeal Guidelines

July 22, 2019

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

ABH - Update on Dispute/Appeal/Grievance Processes

July 2, 2019

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.

ABH - Prior Authorization Codes 2019 Updates

July 1, 2019

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 - Monthly Informational Handouts

June 27, 2019

Meridian has provided these informational handouts for refernece:

  • Potentially Harmful Drug Disease Interactions in the Elderly
  • MeridianRx.com instructions
  • Notifications of Enhanced Claim Review Processes regarding clinical chart/DRG reviews
  • Use of "Request for Claim Dispute" form for better routing of disputes

Meridian - Provider Readmission Review Notice

June 3, 2019

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 - Monthly Informational Handouts

May 29, 2019

Meridian has provided these educational handouts for this month:

  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Medication Reconciliation Post Discharge
  • Antidepressant Medication Management
  • CPTII Codes and HCPCS Billing for Medicare and Medicaid
  • Health Michigan Plan -  Health risk Assessment (HRA)
  • Meridian RX.com

Meridian- Prior Authorization Process Detail

May 29, 2019

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.

 

Meridian Complete and Concerto Health Update

May 20, 2019

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 - Availity training sessions

May 20, 2019

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

Meridian - Monthly Informational Handouts

April 22, 2019

Meridian has provided these informational monthly handouts:

  • Comprehensive Diabetes Care and Controlling High Blood Pressure
  • Chlamydia Screening
  • MeridianCare :  a Message from the Stars and Medicare Stars Overview
  • Breast and Cervical Cancer Screening and The American College of Radiology BI-RADS Atlas and Mammography Quality Standards Act (MQSA)
  • Notification of Change to Inpatient Claim Submission Requirements

UHC: CAHPS Importance of Care Coordination

April 9, 2019

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 - Monthly Informational Handouts

March 28, 2019

Meridian has provided informational handouts on the following topics:

  • Prenatal Care; Scheduling Postpartum Care
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
  • Colorectal Cancer Screening Plan
  • The Health Outcomes Survey (HOS)
  • Access to Care
  • Annual Wellness Visit

In addition, there are informational sheets on:

  • HealthHelp Implementation
  • Provider Notification: New Quality Review Program for Radiology and Cardiology

 

Helpful Info from Priority Health on Serving Lakeland Plan Members

March 15, 2019

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.

LMOA - March 2019 Luncheon

March 4, 2019

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 - Monthly Informational Handouts

March 4, 2019

Meridian has provided some informational handouts on the following topics:

  • Childhood and Adolescent Immuizations: Billing Guidelines
  • Meridian Incentive Program Overview
  • Well Care Exams and Lead Screening
  • Well-Child Exams and Lead Screening
  • Meridian's eviCore Implementation for cardiac and radiological imaging Utilization Management programs
  • Meridian's HealthHelp Implementation for oncology and radiation threrapy Utilization Management programs

 

Breakfast Forum: "Recreational Marijuana and the Workforce"

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?

Reminder - Lakeland Associate Labs Go To Lakeland

February 4, 2019

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.

SWMBH- Paperless Claims Submission Changes

January 31, 2019

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:

New Medicare Advantage Contract Added

January 24, 2019

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.

Insurance Payor Change for Two SW Michigan Employers

January 9, 2019

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 January 2019 Meeting Invitation

January 8, 2019

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: