News

Quarter 2 Cigna Network News:

April 26, 2023
Providers

The Second Quarter 2023 issue of Cigna Network News is now available.

 

Network News is easy to navigate  and it is easy to find what you’re looking for, including policy and network updates, as well as industry tools and resources.

Here’s a handful of quick tips*

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Use the arrows at the top or right of the page to advance or go back a page.

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AZO Services is a New Employer Group Using Auxiant

April 20, 2023
Providers

A new employer group, AZO Services, now has access to the Lakeland Care Network through our Confinity contract.    Effective May 1, 2023, AZO Services will be using the payor Auxiant.  This payor will now have 3 employer groups using them:  South Shore Enterprises, Getman Associates, and now AZO Services.  Auxiant is one of Lakeland Care Network's 'employer-specific payors.   Keep in mind that all Lakeland Care credentialed providers will be considered in network for Auxiant, but ONLY for the three employer groups listed above.

UHC - April 2023 Monthly Updates

April 6, 2023
Providers

Attached you will find the monthly updates for April 2023 from our partners at United Healthcare.

  • Medicaid changes to dental  coverage effective April 1, 2023
  • UHC Network News for April 

 

Priority Health: Prior Authorization Legislation: New Prism Tool, Reduced Turnaround Times and More

April 3, 2023
Providers

As you may know, in April 2022, Governor Whitmer signed the prior authorization reform bill, Public Act 60 (PA 60), into law. We’re excited that this legislation supports streamlining how we work with each other, making it easier for our members – your patients – to get the care they need when they need it. 

 

Priority Health: Clinical Documentation Required for Outpatient Prior Authorizations Starting June 1, 2023

April 3, 2023
Providers

As Michigan’s Prior Authorization Reform legislation (SB 247 / PA 60) goes into effect on June 1, 2023, we’ll implement new requirements for some of our prior authorizations to help ensure timely, appropriate care for our members, your patients.

 

9-day turnaround time

Starting June 1, in accordance with PA 60, we’ll decrease our prior authorization turnaround time from 15 days to 9 days for our commercial, individual / ACA and governmental self-funded plans.

 

Priority Health: New Date Formatting in Payment Reference IDs

April 3, 2023
Providers

On Apr. 1, 2023, our payment reference IDs that accompany claim and capitation payments will change.

 

What’s changing?

The date-related characters in the payment reference ID will change from an 8-character pay date (YYYYMMDD) to a 5 character pay date that uses Julian date logic (YY Julian date).

For example:

  • Pre 4/1/2023: 2021060410300531
  • 4/1/2023 and after: 21155B1000000531

 

BCBS and BCN - Blue Cross Personalized Medicine℠ program impacts to BCN Commercial and BCN Advantage℠ Gain Share 2023 Medical Service Agreement Payment Exhibits

March 27, 2023
Providers

We have received multiple questions regarding the impact the Blue Cross Personalized MedicineSM program has on your annual Product Exhibits.

UHC - Helpful Tips About Submitting Claim Reconsiderations and Appeals Electronically:

March 20, 2023
Providers

Now that claim reconsiderations and appeals must be submitted electronically,* we want to help make sure you have the how-to information you need to manage them with ease.

You have 2 electronic submission options — through the UnitedHealthcare Provider Portal or Application Programming Interface (API). See the Online Reconsiderations and Appeals interactive guide for step-by-step instructions on how to submit reconsiderations and appeals electronically. 

Lakeland Pediatric Sub Specialty Clinic - 2023 Calendar

March 17, 2023
Plan members
Providers

Attached is the 2023 Calendar for the Lakeland Pediatric Sub Specialty Clinic located in the Health Park Medical Suites in St. Joseph.  The providers who round to this clinic are all from Helen DeVos Children' Hospital in Grand Rapids.  The purspose of this clinic is to provide specialty pediatric care right here in Berrien County so parents don't have to take the time to drive their child to and from the hospital in Grand Rapids to see their child's specialist.

LMOA - HIPAA & Privacy Presentation

March 17, 2023
Providers

A big thank you to Brian, Rachel and Amanda from Lakeland/Corwell Health South's Compliance team for their presentation to the LMOA membership on Wednesday, March 15, 2023.  As promised, below is their presentation for your reference.

Humana - March 2023 Program and Informational Updates Part 2:

March 13, 2023
Providers

From Humana, there are more informational handlouts provided for your use, including the Humana Quarter 1 Physician News and Real Tme Benefit Check.

Please read about Humana's  new CenterWell Pharmacy and Prescription program; flyers are attached below for your reference.

Priority Health: Second Medical Opinion Through 2nd.MD Available to Employer Groups May 1, 2023

March 6, 2023
Providers

What we’re doing and why

A patient’s decision about their care can be a big, life-changing decision. 2nd.MD through Accolade is a leader in virtual medical decision-making, connecting people facing high-impact medical scenarios with top specialists through video consultations, to help them make informed health care decisions.

BCBS and BCN - New Radiology Focused Initiative to Improve Quality of Care and Patient Outcomes

February 15, 2023
Providers

Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with Covera Health to launch a radiology-focused quality improvement program to help us better support radiologists and referring providers in their efforts to improve diagnostic quality, overall c

Cigna - New Name: Cigna Healthcare

February 14, 2023
Providers

Today, Cigna is becoming Cigna Healthcare.

 

This evolution of our brand signifies our renewed focus as an advocate for better health through every stage of life, as well as for improving the health, well-being, and peace of mind of our customers – your patients. Together, Cigna Healthcare and Evernorth Health Services will comprise The Cigna Group, a global health company committed to creating better health for all.