News

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.

Humana has provided us the attached Power Point presentation regarding their NEW authorization process -- Cohere.  This process began on 1/1/2021.

Please read the details in this attachment about how to submit a request, the clnical review process, peer to peer consults, and many more details regarding this new authorization system.

Please read the informational attachments for the latest from United Healthcare on COVID-19, Tele-health, The Administrative  Guide for 2021, and much more  in 2021.

Also, please connect with this link to sign up for future emails from UHC:  Please visit: UHCprovider.com/subscribe to sign up!

COVID-19 vaccines

Please read the December 2020 issue of the United Healthcare Provider News Brief for all of the latest  information from UHC..

In addition, COVID -19  authorization process requirement has been postponed until 01/04/2021; please see the attached document for further details

Attached are the Meridian Provider educational handouts for the month of December 2020. There is also important information on Ambetter which takes effect on 1/1/21. This is a Centene Ambetter brand change from Meridian Choice/Comm/HMO  effective in  2021

In support of easing administrative burden during this pandemic, we (Meridian) are reinstituting  many of our operational changes from the spring.  If there’s anything we can do, please let us know and we'd be happy to champion it through the organization. 

Virtual Office Advisory
Thursday, December 17, 2020
Noon – 1 p.m. EST

Join us for our upcoming December Virtual Office Advisory webinar and learn about:

• How to credential nurse practitioners and physician assistants
• 2021 E/M billing changes
• How to review a claim using our claims inquiry tool
• Supporting you and your patients during COVID-19 in 2021

Please see the attached United Healthcare Network Bulletin regarding  2021 updates and changes to programs and policies.. Additionaly, please read the monthly handouts and bulletin..

Like you, we are concerned with the unprecedented surge of COVID-19 cases in Michigan. We strive to understand the unique challenges different states face and determine how we can help.

In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial members for the entire state of Michigan through Dec. 31, 2020. 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.

Attached are the Meridian Provider educational handouts for the month of November 2020.

Commercial formulary updates effective Jan. 1, 2021

In January and July of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs. 

In 2020, we’ve made more than 66 enhancements, including 46 new drugs and changing 20 current drugs. 

Attached are the Meridian Provider educational handouts for the month of October 2020.

CIGNA Network News

Take a peek at one of our top stories

Cigna launches five-year initiative to combat systemic racism

IMPORTANT INFORMATION FROM CIGNA

Interim COVID-19 coverage guidelines extended

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.

Please read the attachment regaarding news from Priority Health on a number of important requrements and changes.

Included in this newsletter are:

• D-SNP Model of Care Training for Physicians DUE 12/31/2020
• Guiding Care Authoriztion tool tips
• Claims processing for providers at temporary locations for COVID-19 ended September 30, 2020
• Incentive PCP Programs
• and More!

See the attachment for detils please.

Introducing Cigna's new Virtual Care Reimbursement Policy

There’s no question. It’s a different health care environment today. But with Cigna’s new virtual care reimbursement policy for commercial medical services, there’s one thing that doesn’t need to change: the connection you have with your patients with Cigna coverage – even if they can’t come into your office, and even beyond COVID‑19.

Please visit UHCprovider.com for the full news brief. 

There is informaiton on a New prior Authorization and Notification tool, information on the expansion of the Dual Special Needs program, and many more important updates

Below is a summary of the October 2020 Network Bulletin.  The entire member can be found at www.UHCprovider.com > Network Bulletin.  in addition, there is 2020 Flu Shot informaiton also attached.   Please review and share with staff.