News

* Get our Q3 Physician and practice news digest and our Q3 Medicare/Medicaid Quality newsletter
*Take action today before your staff loses access to prism
*How do I complete the pSA renewal process?
* Reminder: Unique NPI required for rehab groups to credential BH providers
* Coding policies going into effect September 23, 2024
* Do your Medicare patients qualify for Extra Help?
* Register now to learn about our Q4 Medicare/Medicaid Quality campaigns on August 29, 2024

Aetna Better Health has sent paper copies to offices and has provided LCN this electronic copy of the Spring 2024 Provider Newsletter.

July 2024 UHC Updates:
*New prior authorization requirements for Continuous Glucose Monitors
*Updates to oncology and hematology prior authorization codes for many plans
*Michigan: Prior authorization updates for provider administered medications
*July 2024 Preferred Lab Network list is now available
*Annual federal audit of commercial plans
*Add your merchant ID in My Practice Profile
*Complete special needs plan MOC training by Dec. 31
*Digital Solutions
*Policy and protocol updates See the updates

Priority Health - PriorityActions for providers update July 11, 2024
*Resource to address GLP-1 shortages and support patient medication adherence
*July VOA roundup: watch new Modules and register for upcoming webinars
*Provider trainings for TurningPoint authorizations programs
*Reminder: Attest to your providers’ PCMH designations in PRA
*Prism inquiry turnaround times and when to reach out to our team

*Get free vaccines for your eligible patients through the Vaccines for Children Program
*Register now to learn about our 2025 PCP Incentive Program on July 11, 2024
*Reminder: you must refer members to in-network providers, including labs

Get free vaccines for your eligible patients through the Vaccines for Children Program!
What’s the Vaccines for Children (VFC) Program?

The VFC program is a federally funded program offered through the Michigan Department of Health and Human Services (MDHHS) that provides you with vaccines, at no cost, for your Medicaid-eligible patients ages 0 through 18. VFC program providers get free vaccines for eligible patients and are reimbursed for vaccine administration. 

Want to know more? 

Barry-Eaton District Health Department (BEDHD) and Michigan Department of Health and Human Services are investigating 3 cases of Legionnaires’ disease (LD) associated with Bay Pointe Inn located in Barry County. The cases reported travel to Bay Pointe Inn (11456 Marsh Rd, Shelbyville, MI 49344) between March 2024 and June 2024.

Meridian discovered an internal issue this morning, June 12, 2024. There were several claims denied for CHAMPs eligibility. Offices likely would have seen those denials as F6 or F7. Meridian was able to stop the majority of the claims prior to going out, but unfortunately some had already gone out denied. The problem was due to a broken internal file interface. 

PriorityActions June 6, 2024 Issue. Please visit the Priority Health provider site for full details and updates to the following:
Authorizations, new radiation oncology authorizations programs, incentive programs, pharmacy, requirements and responsibilities, billing and payments,and training opportunities.

New MSK authorizations program will launch September 2024

In addition to cardiac managed care, we’re also partnering with TurningPoint on a new authorizations program for musculoskeletal (MSK) procedures, both slated to launch September 2024.

These programs are designed to facilitate provider-to-provider collaboration on each member’s care plan, with the overall goal to optimize health outcomes and work more closely with you, our provider partners, on evidence-based, value-driven care.

Updates to Emergency Department Facility Evaluation and Management Coding Policy effective July 1, 2024.

Highlighted in this issue are: Incentive programs, Updated 2024 HEDIS guidelines, Updated 2024 PIP manual, May 2024 Medical Policy Updates, Mandatory pSA Renewal process begins June 1, 2024, Reminder to follow ICD-10 guidelines, and Virtual Office Advisory Training on June 13

Blue Cross Blue Shield of Michigan and Blue Care Network will be announcing the alignment of Blue Cross physician organizations and BCN medical care groups in provider newsletters.

The latest issue of PriorityActions for May 9, 2024 include:
*Change Healthcare outage update: Electronic RAs resumed through Change Healthcare and Optum clearinghouses; all services should be restored
*We’re transitioning to 2024 InterQual® criteria starting July 15
*We’re no longer allowing providers to be enrolled under multiple ACN contracts with the same NPI, TIN and address
*We’re requesting medical records for an MDHHS audit
*We’re reprocessing incorrectly rejected Tdap vaccine claims

Meridian has partnered with Evolent (formerly New Century Health) to implement a new prior authorization program. Evolent is a comprehensive Cardiology Quality Management Company. This program is intended to help providers easily and effectively deliver quality patient care.

Effective June 1, 2024, invasive cardiology procedures and services will require prior authorization through Evolent rendered in a physician’s office, outpatient hospital, ambulatory, or inpatient setting (planned professional services only) will require prior authorization through Evolent.

The latest issue of PriorityActions for April 25, 2024 include:
-ID.me identity verification now required for new prism users
-Providers may need to resubmit incorrectly denied COVID vaccine claims for payment
-Hearing aid providers: Invoice submission for Medicaid members is no longer necessary
-PriceMyMeds launching on April 25 to increase prescription drug affordability
-Formulary changes for commercial group and individual members coming July 1
-Aligning with Cognizant engine changes as they’re released
-Helping you get 2024 medication adherence reports into the right hands

The Lakeland Medical Office Association invites you to attend our May luncheon and seminar.

Title:   Wellbeing in the Medical Office

Uncover the science behind stress-reducing strategies.

Discover what is needed for professional fulfillment.

Learn how to foster a culture of well-being in your workplace.

Latest information on the Change Healthcare outage:
Priority Health sent a PriorityAlert on April 2, 2024 with the latest updates on the Change Healthcare outage.

Change Healthcare communications archive:
You can visit the news & education page in your Provider Manual for an archive of communications we've sent about the Change Healthcare outage.

PHP highly recommends utilizing electronic prior authorization (ePA) as the preferred method for obtaining prior authorization for pharmacy prescriptions.

Self-funded plans administered by PHP TPA Services are provided with a unique identification that provides access to Lakeland Care Network providers who are contracted with PHP. Each patient member covered under a TPA plan will be assigned an individual identification card.

From our partners at United Healthcare, they have launched a new program for our offices to get questions answered quickly!

If you are looking for a way to lessen the time you spend on administrative tasks, you can now use their new chat feature located within the United Healthcare Provider portal. See the attachment for details.

For further details, another option is to visit: https://www.uhcprovider.com/  

Lakeland Care Network has signed a contract with Aetna for their Medicaid product. All participating Lakeland Care providers are participating with Aetna's Medicaid for dates of service 1/1/24 and forward.

Lakeland Care already contracts with Aetna Better Health for their Dual Eligible product, which is called "Aetna Better Health Premier."  This newly-signed contract is for Aetna's Medicaid product which goes under the name of "Aetna Better Health".  

Meridian is now accepting post service appeals via fax. When faxing the appeal, please include the attached cover page as well as the claim number associated with the appeal when faxing, as the first page of the submission so that it can be appropriately routed. The attached document indicates that the appeal cover letter can also be mailed if preferred.

The fax numbers for each LOB (MMP and Medicaid) are below:

• Michigan Medicaid Post service appeal: 833-592-0658 
• Michigan MMP Post service appeals: 833-957-0439

Lakeland Care Network would like to share some current information and key facts regarding Measles. 

Attached are three handouts for your reference. Please share with your offices.

Michigan scholarships grow doula workforce

UnitedHealthcare Community & State recently invested $198,000 into regional development of the doula workforce. With this investment, participants are able to apply for scholarships to pursue doula training and relevant continuing education. Along with 20 training scholarships available in Michigan, UnitedHealthcare is working to improve birth outcomes and access to holistic support by building relationships with local doula organizations.

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.

Thank you all who joined us at the Hilton Garden Inn for our annual payor conference.  It was so much fun to get together again and see our friends in person! We hope you found our conference helpful and, as promised, below are the presentations by our payor partners:

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.