Priority Health - Post-PHE Member Coverage Changes, Virtual Care Billing Updates Go Into Effect May 12
On May 11, 2023, the COVID-19 public health emergency (PHE) is scheduled to end.
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Below is the full list of contact information for Valenz Health:
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.
Attached you will find the monthly updates for April 2023 from our partners at United Healthcare.
Humana has made siginificant changes to their commerical products in regards to preauthorization and notifications in 2023
Please visit this link for all Humana updates:
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.
On May 28, we’ll implement the new clinical edits listed below and outlined in detail in the following documents:
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.
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.
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:
This update applies to both our commercial and Medicare members.
Effective March 1, 2023, we will no longer require precertification for the site of service for vitrectomy procedures.
The following new-to-market drugs require precertification....
We have received multiple questions regarding the impact the Blue Cross Personalized MedicineSM program has on your annual Product Exhibits.
Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You are invited to attend a Veterans Affairs Community Care Network Overview educational session.
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.
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.
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.
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.
From Humana, there are a number of informational handouts and flyers on their program updates. Please read the attachments for all that may apply to your offices.
Thank you,
Dear BCN-Affiliated Medical Care Group Business Administrator:
We recently fixed an error with a clinical edit impacting the following services:
From United Healthcare, please read the provided attachement for the latest updates as of March 2023.
We’ve partnered with Livongo to offer a digital diabetes management program to your commercial fully funded patients with type 2 diabetes. This program will strengthen the care you provide and offer the extra support your patients need to manage their health.
We’re reissuing new ID cards to our commercial members to update the pharmacy processing information on the back of their card. This change will take effect April 1. Members will receive their new cards between March 31 and April 28.
Dear BCN-Affiliated Medical Care Group Business Administrator:
As of Mar. 1, 2023, providers now have 60 days post authorization denial to file a level I appeal. If that appeal is denied, they’ll have 30 days post level I appeal denial to submit a level II appeal.
The February tragedy at Michigan State University has had a significant impact on our members and your patients. Your physicians likely have patients who could benefit from behavioral health or care management services.
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.
LMOA is an independent, non-profit organization dedicated to providing quality education to
southwestern Michigan's healthcare community.
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
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.
Attached you will find the latest updates provided to us by Humana. Please read and share the first quarter of 2023 Physician News updates with your offices
Attached you will find the latest updates provided to us by Cigna. Please read and share the first quarter of 2023 Network News updates with your offices
LMOA is an independent, non-profit organization dedicated to providing quality education to
southwestern Michigan's healthcare community.
Dear BCN-Affiliated Medical Care Group Business Administrator:
From United Healthcare, please read the provided attachments for all updates to UHC as of February 2023.
Meridian is notifying our network of a new program offering to their Ambetter members.
These letters are being sent out to the Ambetter providers (please review the attachment below). Some key information is below:
Dear BCN-Affiliated Medical Care Group Business Administrator:
Dear Medical Care Group Business Administrator:
Attached are the following updates and provider educational opportunity, please share with your team and providers.
Humana Claim Resolution Guideline Update
Friendly reminder from Humana:
Attached is letter that went out to providers early December 2022.