Latest news

Please see the attached notification of upcoming ASR changes impacting the areas of:

• Pre-certification for Outpatient Infusion & Injection Therapy
• Increased dollar threshold for medical equipment requiring pre-certification

The updated version of these requirements will also be included in a revision to the Provider Administrative Manual, which is available online through the ASR Provider Portal.

Also attached, is a revised “At-A-Glance” page, reflecting these changes. 

A repeat of a previous article.

For MeridianChoice, commercial product found on the exchange, attached you will find the Prior Authorization list for services.

On September 28, 2018, Cigna changed how providers will register for, and obtain the appropriate level of access to, the Cigna for Health Care Professionals website (CignaforHCP.com).* Now, newly assigned website access managers at each practice will manage these functions.

Important New Medicare Card Mailing Update — Wave 7 Begins, Wave 5 Ends

Thanks to all who spent the afternoon with us this week at the annual Lakeland Care Network Payor Conference. We hope it was a valuable day for you and your office or department.  Attached are presentations for your reference.  The link to ASR's summary is here.

Updated Medicaid Managed Care Plan Provider Enrollment Timeline

August 29, 2018: Health care providers that serve Medicaid beneficiaries are facing an upcoming enrollment deadline that is necessary for them to continue to receive payments from Medicaid. 

While the Michigan Department of Health and Human Services (MDHHS) has revised the timeline to give providers more time to enroll, the department is urging providers to complete the screening and enrollment process as soon as possible.

The Centers for Disease Control and Prevention (CDC) recommends that patients 6 months and older receive an annual flu vaccine.

This year’s seasonal flu vaccine will cover the three most common strains in the Northern Hemisphere, as identified by the CDC:

• A/Michigan/45/2015 (H1N1)pdm09-like virus

• A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus

• B/Colorado/06/2017-like (B/Victoria/2/87 lineage) virus

Please read the attachment for additional information.

Humana’s secure medical provider portal is closing. Please make the switch to Availity now.

This is a repeat of an article originally posted on July 23, 2018 on the LCN website

On Oct. 3, 2018, the Humana.com secure medical provider portal will close. Use the Availity Provider Portal instead to work with us online.

Take action today to avoid interruption to your work

ABH has provided new informational handouts on the following topics:

• Provider Notification on Urine Drug Testing
• Urine Drug Testing: Evidence-based Test Ordering

Peer-to-Peer Reviews – Improved Scheduling

In an effort to respond to network provider feedback with respect to the scheduling process of peer-to-peer reviews, there is a new effort underway at UHC to improve the provider experience with our Peer-to-Peer review process.

The Lakeland Medical Office Association invites you to attend our October luncheon and half-day meeting, sponsored by the Lakeland Care Network.

Program:          Lakeland Care Network’s Annual Payor Conference

This year’s Payor Conference will feature the major payors in our market – including those who have Commercial, Medicare, Medicaid and dual eligible products.  Lakeland Care will also provide an update on our network's current projects and future initiatives.

Meridian has provided some informational handouts on the following topics:

• Influenza Vaccination
• BMI Measurement and Counseling for Nutrition and Physical Activity
• Prenatal Care/ Scheduling Postpartum Care
• Chlamydia screening

Starting October 1, 2018, UHC-CP is changing their Obstetrical Ultrasound Policy to further align with Medicaid guidelines. Medicaid doesn’t consider ultrasounds to be medically necessary if they’re done only to determine the fetal sex or provide parents with a photograph of the fetus. A detailed ultrasound fetal anatomic examination is also considered medically unnecessary for a routine screening of a normal pregnancy.

What’s Changing

UHC-CP willl implement these guidelines for claims processed on or after October 1, 2018:

Meridian has provided some informational handouts on the following topics:

• Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
• Dental Care Information
• Appropriate Treatment for Children with Upper Respirator Infection/ with Pharyngitis
• Well Child Exams and Lead Screening
• Potentially Harmful drug-Disease  Interactions in the Elderly
• Childhood and Adolescent Immunizations
• Colorectal Cancer Screening
• Medication Reconciliation Post Discharge

LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.

Katie Rogers, our SW Michigan Provider Relcations Consultant for Blue Cross, has informed us that beginning 10/1/18, Blue Care Network (BCN) will utilize AIM for cardiology and high-tech radiology prior authorizations. If your office or department requests prior authorizations, please take advantage of several webinars that BCN has created for you.

The Affirmant's Third Annual Leadership Retreat was recenlty held.

Attached is a newsletter highlighting the events.

Priority Health is making changes to their eviCore prior authorization program based upon your feedback to better serve you while ensuring our members are getting high quality, cost effective care.

Starting on Sept. 5, a subset of the high-tech radiology CPT codes will stop auto approving and will require authorization.

This means:

Some requests may pend for additional information. Once the information is received a decision will be made within two (2) business days.

Humana’s secure medical provider portal is closing. Please make the switch to Availity now.

On Oct. 3, 2018, the Humana.com secure medical provider portal will close. Use the Availity Provider Portal instead to work with us online.

Take action today to avoid interruption to your work

The most up-to-date tools for working with Humana online are already available on the Availity Provider Portal. Please make the switch to Availity now to ensure continued access to Humana’s secure online tools.

In October 2018, Humana will be permanently closing their secure portal on Humana.com and migrating to Availity.com. 

Attached you will find an Availity Webinar Schedule if anyone in your office needs assistance, as well as an informative PDF about the upcoming switch.

Meridian has provided informational handouts on the following topics:

• The American College of Radiology BI-RAD ATLAS and Mammography Quality Standards Act (MQSA)
• Breast and Cervical Cancer Screening
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Care for Older Adults
• Preventing Readmission: Following up with Discharged Patients
• Meridian Provider Portal Update

New Medicare Card: MBI Look-up Tool Available through your MAC

Attached you will find a listing of all services that require pre authorization for your Patients with Meridian Choice coverage.  A PCP visit does not require a prior authorization.  Meridian Choice is a option offerered on the Health Insurance Exchange.  LCN does PAR with this this plan.

Preparing for an Aging Workforce

Are you prepared for an aging workforce? Does your organization have resources available to employees with aging or ill family members? Many people do not know where to turn for help when faced with challenges related to aging, retirement, illness, palliative care or end-of-life related situations. Learning about the aging workforce is an opportunity to better prepare your organization and your employees for this change of life.

We’re committed to making it easier for you to do business with us. Our new Precertification web page is one of the many ways we are working to deliver on that commitment. On this new page, you’ll find:

Meridian has provided information sheets on the following topics:

• Comprehensive Diabetes Care
• Controling High Blood Pressure
• Healthy Michigan Plan - Health Risk  Management
• Medication Management for People with Asthma
• Tips for Improving Medicatieon Adherence
• Well Care Exams
• Lead Screening
• Meridian - What We Do

Beginning July 1, 2018, Priority Health will be preferring the use of biosimilar infliximab products over Remicade for commercial, individual and Medicaid products:

Prior to July 1:

Attached is information from United Healthcare regarding their new Dual Complete (HMO-SNP) program. Attached are two resources for your reference. There is a powerpoint which explains the program in detail, as well as a Quick Reference Guide for a handy reference.

UHC has recently made additions to our UHC- Community Plan website.  The prior authorization list for our Dual Complete Plan should be easier to find now.  See the following links:

http://www.uhccommunityplan.com/health-professionals/mi.html

http://www.uhccommunityplan.com/health-professionals/mi/provider-forms.html

The Lakeland Medical Office Association (LMOA) invites you to attend their April luncheon and meeting.

PROGRAM:  Risk Mitigation Best Practices in the Physician Office

Attached is the list of apps that was discussed at the March LMOA presentation on Human Trafficking.  The apps listed are ones that the Michigan Human Trafficking Task Force encourages parents and teachers to know about.

Lakleand Care has learned that Priority Health has only loaded some of the midlevels that we have credentialed since September of 2016, which is causing billing issues for our practices and hopsitals. Therefore, for Priority Health patients only, please continue to bill services provided by your midlevel practitioners, under their supervising Lakeland Care physician until further notice.

Lakeland Care Physicians and Advanced Practitioners:

We continuously encourage Lakeland associates and their spouses to have an ongoing relationship with their Primary Care Providers.  A new requirement, for Lakeland’s myHealth Wellness Program in 2018, is for participants to have a wellness visit between 1/1/2016 and 10/31/2018. Participants will receive credit based on the Z billing codes for wellness; additional paperwork is not required.

The Lakeland Medical Office Association (LMOA) invites you to attend our March luncheon and meeting.

PROGRAM:  The Reality of Human Trafficking in Michigan

Sex trafficking does not happen only in big cities. It is an evil that lurks throughout this country and around the world. It’s time to expose the darkness.  Come hear a personal story of survival, from Melinda, a human trafficking survivor.

Below is the pdf of the handout that Ellen Berra provided at the Lakeland Medical Office Association luncheon on Wednesday, February 21, 2018.

UnitedHealthcare Dual Complete (HMO-SNP) is now offered by UnitedHealthcare Community Plan of Michigan

Effective Jan. 1, 2018, UnitedHealthcare Community Plan of Michigan will begin to serve eligible members in a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete Medicare Advantage ‒ in the following counties: Berrien, Branch, Gratiot, Hillsdale, Tuscola and Washtenaw.

The Health Insurance Claim Number (HICN) is a Medicare beneficiary’s identification number, used for processing claims and determining eligibility for services.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medical identity theft.

MACRA requires that CMS mail out new Medicare cards with a new Medicare Number by April 2019. Medicare will start mailing new cards in April 2018.

North America Administrators (NAA) was one of Lakeland Care's Employer-Specific payors. Lakleand Care providers participated with NAA only for the K&M Machine covered employees.  Lakeland Care just received notice that K&M Machine terminated with NAA effective 8/31/17. We are not aware of what payor they might have moved to.  Therefore, please ask K&M patients for an updated insurance card.

The Lakeland Medical Office Association (LMOA) invites you to attend our February luncheon and meeting. Please note that this presentation is 1 hour longer than our standard programs.

PROGRAM:  Medicare Denials and How to Avoid Them

UHC has recently made two additions to their UHC-Community Plan website. DSNP  Prior Authorization Lists and Frequently Used Forms information regarding the Dual Complete Plan should be easier to find now. 

The following links will  provide you easier access in finding information on the UHC-CP site: