United Healthcare has provided these informational handouts for May 2021:
Since the COVID-19 pandemic began, we have 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.
Aetna now offers providers ability to submit appeals electronically via Availity as of 1/25/21. Attached is a handout that has screen shots and tips of the process with explanations that can help provider offices use the new process!
Attached is a chart that will be useful to offices on how to navigate questions within the Priority Health portals.
This announcement is applicable to all in-network hospitals and all in-network skilled
nursing facilities (SNFs) in the Detroit-Warren-Dearborn, Kalamazoo-Portage, Lansing-
East Lansing and Flint, Michigan Metropolitan Statistical Areas (MSA).*
During the COVID-19 national public health emergency, UnitedHealthcare is temporarily
The latest COVID-19 updates
As the COVID-19 vaccines continue to be distributed across the country, we are committed to ensuring providers have the latest information related to our response to COVID-19. The following information outlines some of the latest updates, including increased vaccine reimbursement, encouraging patient vaccinations, our coverage of COVID-19 tests, and accommodations we continue to make during the public health emergency (PHE) period.
Please read the attachment for all of the latest details from CIGNA.
From Priority Health:
Thanks to your feedback, we’re planning several enhancements to GuidingCare authorization process in 2021. These changes will speed up some authorizations, giving your practice more time to focus on patient care.
Today, the following enhancements start:
Priority Health has shared a handout that helps offices navigate questions as they may arise. Plese read and print the attachment for all of the details!
The Telehealth PCP is a new plan that just launched in 2021 for Individual members. The plan offers virtual-first primary care coverage through our partner, Doctor on Demand®. However, by choosing this plan, members are assigned a PCP from Doctor on Demand. Any in-person care needed is referred back to the Priority Health HMO network.
Individuals can choose their own plan during open enrollment either through the marketplace, their agent or Priority Health directly.
Billing and temporary provision updates, member outreach to encourage vaccinations
UnitedHealthcare is revising our COVID-19 resources to reflect additional billing guidance, and updating a number of temporary cost share provisions that were established as part of the COVID-19 response. Here’s a high-level summary of the changes and effective dates
Please read the attachment for all of the NEW details from United Healthcare!
Attached you will find the monthly handouts from Meridian for the month of March 2021:
Topics include:
Provided to you from United Healthcare:
Please review the attached Medicaid home blood pressure cuff coverage grid that has been created by the State of MI. The grid can be used by providers to check inclusion criteria, preauthorization requirements, and special instructions specific to each to the UHC managed care plan prior to prescribing blood pressure cuffs to patients with hypertension for blood pressure self-monitoring. .
Michigan Department of Health and Human Services (MDHHS) Blood Pressure Cuff Coverage Grid
Dear Medical Care Group Business Administrator,
If you or any of your physicians participate in electronic claims transactions with Blue Cross or BCN, you need to take action. Please forward this information to your billing contacts to ensure there are no gaps in communications.
Background
From CIGNA--
AS A TRUSTED SOURCE, YOU CAN MAKE THE DIFFERENCE IN GETTING VACCINE HESITANT PATIENTS PROTECTED
Only 26% of respondents say they have asked a health care professional for information about the vaccine so far. – Kaiser Family Foundation Report on Vaccine Hesitancy
From our Partners at United Healthcare:
Many of you are aware that Microsoft is no longer going to support IE11 (Internet Explorer) starting 8/17/21. We have been partnering with UHC Digital on an education strategy to our Core/Strategic providers who are using EI11. Since Link and the Provider Portal will be impacted it is important our providers make the transition over to a new browser.
UnitedHealthcare online tools and web compatibility
Effective April 5, 2021, you will be directed to GuidingCare to request musculoskeletal authorizations, instead of eviCore. Our portal will direct you automatically to GuidingCare as you start to enter the authorization details.
There are no new authorizations or other changes currently. You’ll continue to use eviCore for high-tech imaging and genetic testing authorizations. Retro authorizations for musculoskeletal services will continue to be processed by eviCore.
United Healthcare has provided the March informational handouts. The topics include:
Please read the attachments for details.
On Oct. 22, 2020, Governor Whitmer signed two bills (Public Act No. 234 and No. 235) into law that forbid out-of-network PARE providers from sending surprise bills to patients. Surprise billing, or balance billing, has never been allowed for our participating providers.
Aetna Medicare member IDs are changing from the alpha numeric mix of MEB or MED**** to 12 digit numbers starting with ‘10’. See below on the info/details and ID card examples
Member ID numbers are changing
If a claim for a 2021 date of service is submitted using an older 2020 HMO member ID, claims logic is in place to evaluate the member ID and the DOS and redirect the claim to the appropriate claims platform.
Aetna Better Health has provided these flyers as their monthly updates and NEW fax numbers for offices:
Provider Bulletin No 182 – ABH MI Prior Authorization Fax Numbers – effective 1.29.2021
There are three websites offered by Ambetter / Meridian Health as resources to providers and their offices:
Medicaid – Mhplan.com
Complete - https://corp.mhplan.com/en/provider/michigan/complete/
Ambetter – ambettermeridian.com
Please read the attached newsletter for February 2021 from UHC for all of the latest details.
A preview: To ease the administrative burden you may be experiencing in submitting COVID-19 vaccine administration claims for Medicare beneficiaries, UnitedHealthcare has made it easier for you to find a member’s Medicare ID number. We also have a tool to help members find state and county health department resources on FDA-authorized vaccines, as well as materials you can use to encourage your patients to wear masks – a critical step in reducing the transmission of COVID-19.
The dates for our 2021 behavioral health collaborative care (BHCC) meetings are now available. Provider organizations are required to attend at least three Priority Health-sponsored BHCC meetings as part of eligibility requirements for the BHCC incentive.
Other BHCC eligibility requirements include:
From Humana:
As we continue to monitor the status of COVID-19 cases and review procedure data in the 22 states listed below, we are implementing changes to authorization requirements.
Humana is reinstating authorization requirements for Medicare Advantage and commercial members for skilled nursing facilities (SNFs) for dates of service on or after March 1, 2021, in these states:
Statewide reinstatements
o Arkansas
o Colorado
o Delaware
o Idaho
o Indiana
o Kansas
o Kentucky
If there are questions regarding veterans and their coverage, please visit the site below for the latest updates:
https://provider.vacommunitycare.com/tpa-ap-web/?navDeepDive=VACCN%20publicNewsAnnouncementsMenu
Information to sign up for Centine (Meridian Health) Monthly Provider Updates can be found by registering at: mhplan.com
Currently, there also are Complete and Ambetter independent websites that providers could register for access to those websites and look for any current updates,
To access Ambetter website: ambettermeridian.com
Cigna has entered into a new Strategic Alliance with Priority Health. This partnership enables us to leverage
the best capabilities of both organizations, and deliver a health care experience in Michigan’s Lower
Peninsula that is more predictable and simplified for providers and customers.
What you should know
From Humana --
An important message regarding Humana’s COVID-19 response: ADMINISTRATIVE UPDATE Jan. 20, 2021
Like you, we are concerned with the unprecedented surge of COVID-19 cases in Arkansas, Colorado, Delaware, Idaho,
Indiana, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma,
Pennsylvania, Texas, Utah, Virginia and West Virginia. We strive to understand the unique challenges different states face
and determine how we can help.
Gaishin Manufacturing is one of Lakeland Care's employer-direct contracts that utilize Claims Choice as their payor. Last year your office was participating with Claims Choice only for two employer groups: Gaishin Manufacturing and Supreme Casting.
Stay informed about COVID-19
Latest COVID-19 news from UnitedHealthcare – Updates to temporary COVID-19 treatment and prior authorization provisions, reminders on vaccine administration reimbursement
Thank you for all the work you continue to do to care for your patients during this time. We are sharing the following updates to help you deliver care and be reimbursed for the services you provide:
Please review the attached documents sent to us from Aetna Better Health for January 2021:
Since the COVID-19 pandemic began, we have 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.
Attached you will find the United Healthcare Network News Bulletins and the UHC Telehealth update for January 2021.
Humana is providing these documents as a resource for practices:
From Humana:
The Centers for Medicare & Medicaid Services (CMS) published the 2021 Medicare Physician Fee Schedule (PFS) final rule on Dec. 1, 2020, expanding Medicare-covered telehealth services to similar services already covered under the Medicare program. Please note:
Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.
What you need to know
Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.
Examples of fraudulent requests:
An Update from Priority Health:
As COVID-19 vaccines begin to be more widely distributed in our communities, we’re sharing information on billing and reimbursement for the vaccines and administration.
You should not collect any member cost share, such as copays, for first or second doses of COVID-19 vaccines or administration of the vaccine.
