Latest news

Priority Health is making changes to their 340B program based on your feedback. PH will now review 340B claims post-payment, which means that they will review paid claims quarterly.

What can facilities expect?

The first post-payment review will begin in December 2019 for providers enrolled in the 340B program. We may contact facilities for a list of drugs purchased through the 340B program or for specific exclusion criteria.  

Does the 340B program apply to Medicaid claims?

MeridianComplete (Medicare-Medicaid Plan) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective January 1, 2020. This program is designed to work collaboratively with providers in promoting patient safety through the practice of high-quality and cost-effective care for MeridianComplete members undergoing musculoskeletal surgical procedures.

Please see the attachment for details.

Register for a webinar about hyaluronic acid products for knee injections

Meridian is providing monthly handout on these following topics:

• Breast Cancer Screening (BCS) and Cervical Cancer Screening (CCS)
• Adult BMI Assessment and Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
• Well-Child Exams and Lead Screening (LSC)
• Timeliness of Prenatal Care (PPC) and Postpartum Care
• Notice Regarding Authorization for Medicare and Turning Point Implementation

Effective Jan. 1, 2020, Medicaid outpatient behavioral health therapy will no longer require prior authorization. You will no longer need to submit clinical documentation for these requests.

Why we’re making this change

We’re removing the authorization requirement to improve members' access to the mental health services they need to ensure they’re able to get the right care at the right time.

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 November luncheon and seminar.  

Program:  Revenue Cycle – Tips & Tricks to Aggressively Monitor your Financial Performance

 Priority Health offers monthly educational Virtual Office Advisory (VOA) webinars to our providers and their staff. Priority encourages participation in regularly viewing these presentations.

Recently, Meridian has been receiving a significant number of claims where a prior authorization was not obtained.  

Attached are the informational handouts from Meridian for October:

• Medication Management for People with Asthma (MMA)
• Comprehensive Diabetes Care (CDC) and Controlling High Blood Pressure (CBP)
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
• Preventing Readmission: Following up with Discharged Patients
• Transitions of Care (TRC)
• eviCore Expansion Prior Authorization Overview Training Sessions
• Catching a Breath Program Informationa and Referral Form

All patient reviews will be posted to the Cigna for Health Care Professionals website (CignaforHCP.com). They can only be accessed by the providers for whom they were submitted or their delegated office staff. To view, read, and respond to reviews, providers and their delegated office staff must be registered users of CignaforHCP.com.

Below is Humana's link to Availity. It is optional for providers, but encouraged for easier processes.   Availity is efficient to use rather than traditional calling/faxing when working on the following:

Noted in the September Monthly Provider Notification, the Meridian Medicaid Authorization lookup tool for MI and IL has been updated.

As previously discussed, the following improvements have been made to the tool:

-          Additional Blanket Statements added

-          Both excel and PDF versions posted to our website

-          Accessibility on the website was updated to provide easy access to the tool. Providers now can access directly from the home page through the provider tool “Prior Auth Form and Requirements”.

eviCore healthcare and Meridian are expanding their partnership to include the following programs: physical therapy (PT), occupational therapy (OT), genetic testing, pain management, and sleep studies. eviCore will be leading orientation sessions designed to assist you and your staff with the new programs. You will be able to attend the web orientation session that works best for you and your schedule.

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.

Attached are the informational handouts from Meridian for September:

• Low Back Pain and the Use of imaging Studies/ Acute Bronchitis and the Use of Antibiotics
• Pneumococcal Vaccination
• Influenza Vaccination
• American Sign Language Translation Service

HealthSCOPE Benefits (HSB) is the Benefits Administrator for Whirlpool Corporation medical plan participants.  We wanted to make sure you and your billing teams were aware that effective October 1, 2019, the PPO provider network for the Whirlpool Corporate members will change to the United Healthcare Choice Plus Network.   In addition, Whirlpool plan members will continue to have in-network access to all of the Lakeland Care Network providers as they have had in the past. 

US Health & Life is the only remaining LCN contracted payor who is a part of our Cofinity contract  that remains to switch for claims address changes.  Their change date is set for 10/1/19.

Important:  Some Payer EDI #’s were updated since the last version, please look for the Payers with an asterisk next to their name as those EDI#’s will need updated for accurate routing!

UHC-CP has issued some new member ID cards.  Please see the attachment for sample cards for the following product lines:

• MA or Medicaid
• HMP or Healthy Michigan Plan
• DSNP or Dual SNP Plan

Program:        Value-Based Care:  Why, Perspectives, & Future Trends

If you pick up any health care trade publication, you cannot avoid reading a headline regarding efforts to improve “health care value.” However, the what, how and when behind this detailed work varies depending on who you ask; the health plan, the provider, or the patient.

eviCore Healthcare and Meridian are expanding their partnership to include the following programs: physical therapy (PT), occupational therapy (OT), genetic testing, pain management, and sleep studies. eviCore will be leading orientation sessions designed to assist you and your staff with the new programs. You will be able to attend the web orientation session that works best for you and your schedule

Meridian Health is asking providers to complete their Annual Model of Care (MOC) training for ALL providers who care for their plan members.

You can find this training module at their website: www.mymeridiancare.com for additional instructions; also, please see attachment for full instructions and details on this training from Meridian Health.

Note: One person in the office can take this training, and then train the rest of the office.

Please call Meridian Health for any questions at 1-877-902-6784.

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:

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

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:

• 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 

August is National Immunization Awareness Month

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:

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

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:

• 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

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:

• 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

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