News

Priority Health - Get your Questions Answered

 PH has provided a resource to our offices that may help navigate and answer typical questions that arise during the normal day-to-day operations in your offices.

Please read the attachment and even print this handy resource. 

Attached is the announcement of our Meridian Medicaid portal as the old portal at mhplan.com will no longer exist after 4/1/2022. Please register for the new portal by 3/1/2022 to avoid delays however if you are already registered with Meridian Complete portal you will not have to re-register. Members will receive new membership cards before 4/1/2022. After 4/1/2022 auths will be processed through the new provider portal.

You may need to resubmit rejected claims for your Medicaid patients who also have other insurance. 

Hello Hospital Partner-

COVID is surging across the US with many providers requesting assistance because of the rise in cases and shortage of staff.  Aetna recognizes the need to move to a National SNF Waiver effective today, January 6, 2022 through January 31, 2022. The attached communication has been updated to reflect the expansion.

From our Parrtners at Humana:

Michigan - Humana is suspending authorization requirements for skilled nursing facilities (SNFs)for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Michigan through Jan. 16, 2022. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.

Please share with your team and providers.

Do you see PriorityMedicare patients? Take 15 minutes to complete your D-SNP Model of Care training

Training must be completed by Dec. 31, 2021.

Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That’s why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who treat our PriorityMedicare D-SNP™ members are trained on our Model of Care.

From our partners at AETNA:

Hello Hospital Partner- an update that only applies for acute hospitals and SNFs

Attached noticed was supposed to go out to hospitals but in case you haven’t received or info didn’t make its way to you yet I wanted to make you aware that Aetna has liberalized Initial SNF Auths from Acute Care Hospitals since 11/22/21 and goes through 1/10/22.  I attached a notice if need to share as has all the details.  Please share as needed within your system.

Dear Physician Organization and Medical Care Group Business Administrator:

The Oxford school incident has had a significant impact on our members. Blue Cross Blue Shield of Michigan and Blue Care Network have been working with first responders to assist our members. We recognize that the shock waves of this tragedy have been felt across the state and combined with the approaching holiday season and the ongoing pandemic, your physicians likely have patients who could use behavioral health services.

December 2021 policy and protocol updates overview from United Healthcare

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

Please see the attachments for November 2021. 

• Provider Bulletin No 195 – Availity Flyer -   Beginning February 1, 2022, you’ll no longer have access to Aetna Better Health tools and transactions currently located on the Medicaid Web Portal. On Availity, you only need ONE user ID and password to work with Aetna Better Health and other participating payers in your region. 
• Change of Claims Mailing Address -   PO Box 982963 El Paso, TX 79998-2963  

Wishing you a Happy Thanksgiving,

In July, Priority Health shared plans to move musculoskeletal (MSK) services to InterQual® criteria. In addition, there are a couple other changes happening Jan. 1, 2022.

What’s changing

As of Jan. 1, 2022, we’ll launch the following updates to our prior authorizations:

Please read the attached for all of the latest from Priority Health regarding news for physicians and practices!

CIGNA has provided the attachment regarding details of their extension of their policy regarding COVID-19:

Since the COVID-19 pandemic began, Cigna has taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.

Please see the full attachment below for details.

Priority Health: As health care evolves, we want to continue to partner in the best ways possible with you, our provider network. We evaluated our management of spine services and will retire our Spine Center of Excellence (SCOE) program on Jan. 1, 2022.

What’s changing

We’re moving away from the physical medicine and rehabilitation (PM&R) requirement in our SCOE program. Instead, we’ll use prior authorization focused on nationally recognized criteria developed by InterQual® to manage spine services.   

Aetna Better Health has provided these handouts for your office:

Provider Bulletin:

• Provider Bulletin No 194 – GIC Availity – registered Availity users have access to gaps in care information  

Fax Blast to Medical Practices:

• Change of Claims Mailing Address -   PO Box 982963 El Paso, TX 79998-2963

Please read the materials that United Healthcare has provided for their October 2021 news.

Network News Brief:

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An ABH Update: 

New P.O. Box Address and Vendor for Paper Claim and Claim Correspondence – Effective 11/15/2021

P.O. Box #66215 Will No Longer Be Valid Starting November 15th, 2021.

New P.O. Box

Aetna Better Health of Michigan

P.O. Box 982963

El Paso, TX 79998-2963

September 2021 IInformation from Meridian Health regarding theeir product lines of business:

The Michigan Market temporarily suspending  Authorizations for Discharge to SNF as a response to hospitals being overwhelmed with COVID-19 in Michigan.  This solution will be put into place 9/27/2021 until through 10/28/2021, and then will be reevaluated. 

1. For CMU for MMP, Ambetter and Medicare