There are LIVE provider training sessions thru Availaty. Please see the schedule of training sessions at the link:
https://www.humana.com/provider/medical-resources/claims-payments/making-it-easier
The link to sign up to receive the quarterly newsletters to your inbox instead of having to go out to Humana.com to view them:
Dear Provider,
Attached are the September 2021 monthly handouts and bulletings from United Healthcare:
Listed below are some links for offices to follow the updates to the Tele Health policies of some of our payors.
Humana:
https://www.humana.com/site-search-results#q=telehealth
Meridian:
Please read the attached Provider Bulletin from Aetna Better Health:
Starting January 1, 2021, Priority Health and Cigna have entered a Strategic Alliance which means:
• Cigna commercial group members that get care in Michigan can access the Priority Health preferred provider organization (PPO) network.
• Priority Health commercial group members that get care outside of Michigan have access to the Cigna network.
Attached is the quick reference guide to navigate processes within the Cigna and Priority Health alliance.
United Healthcare has provided this attached information for offices to refer to when dealing with prior authoirzations as well as admission authorizations for Medicaid members.
Please share with your offices.
Please read the informational handouts from United Healthcare regarding UMR guides and contact information that are attached below. These will be useful for your practices.
From United Healthcare, attached you will find the August 2021 bulletins and informational flyers.
August Network bulletin summary.
Please see the attached July 21 Informational Handouts from Meridian. The topics this month include:
Ambetter Policy Implementations: new policies Ambetter will be implementing effective June 1, 2021
2021 Meridian Health PCMH Incentive Program
Provider Bulletins & MSA Updates
COVID-19 Billing Guide - updated July 19, 2021:
COVID-19 Guide - updated July 20, 2021:
A copy of the Priority Health Medical Policy, for Telemedicine (telehealth), as of June 30, 2021, is attached below.
Please note, all PH Medical Policies are located on the Priority Health Provider Portal, for Provider review and future reference.
All medical policies can be accessed using your office account thru the Provider Portal with Priority Health. A direct link is:
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.
Extension of key accommodations
We are happy to announce that the Humana CCM Digital Provider Strategy team will be holding regularly scheduled live webinars to demo and train providers on the Availity Overpayment Tool. These webinars will typically be scheduled for the first Tuesday and Thursday of the month at 10:00am or 1:00pm (EST).
Priority Health has now provided their Spring 2021 Provider and Practice News Digest. The following important informaiton can be found in the links below:
Changes to our musculoskeletal authorizations coming Jan. 1, 2022 | more
For Meridian, information regarding the Payor ID changes that took effect on 1/1/21 is located on the Meridian website under Provider Resources/ Bills and Payments.
Availity Customer Support: 800-282-4548
Please check the member ID card for the changes which took effect on January 1, 2021
Please see the attachment for a printable handout for your office of these numbers and details.
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From Priority Health:
Our goal is to work with our provider partners to optimize health outcomes while providing evidence-based, value-driven care. This is why we’ll move to nationally recognized criteria for our musculoskeletal authorizations starting Jan. 1, 2022.
Why are we making this change?
July Network Bulletin overview
Medical policy updates
Aetna Better Health has scheduled a time to explain the detail of what’s new on the Availity Portal for Aetna Better Health.
ABH will provide free trainings and also offer any assistance you may need on the Availity Portal. Please don’t hesitate to forward the webinar information to any of your team members.
From Priority Health on updated information regarding their Telehealth program, including Doctors on Demand.
Please see link below as well as attachments for detailed information surrounding the telehealth product including co-pays, deductibles, etc.
MyPriority HMO Bronze 8550 - Telehealth PCP | Priority Health
Attached is the 2021 Provider Manual from Humana to reference in offices.
Beginning July 1, 2021, National Imaging Associates, Inc. (NIA) will provide utilization management for Interventional Pain Management (IPM), outpatient rehabilitative and habilitative physical medicine services for Meridian’s membership. This program is consistent with industry-wide efforts ensuring that IPM and physical medicine services provided to members are consistent with nationally recognized clinical guidelines.
McLaren has provided this below information in their June 2021 Provider Network Update:
AUTHORIZATION CHANGES - EFFECTIVE AUG. 1, 2021
Effective Aug. 1, 2021 McLaren Health Plan will require authorizations on all inpatient stays with a COVID-19 diagnosis. The authorizations are being reinstated for all lines of business, at all facilities, excluding DME. Facilities with an APM agreement should follow the APM guidelines for authorization requests.
United Healthcare has provided these June 2021 monthly handouts.
From BCN to offices:
Dear Medical Care Group Business Administrator:
The attached 2021 issue of BCN Partners in Care mailed in May to all contracted Blue Care Network providers, one copy per address.
The cover letter focuses on the lessons learned from the COVID-19 pandemic, particularly the versatility of providers, the need for more equity in health care and Blue Cross and BCN’s focus on behavioral health support for members.
As of 1/1/21, Lakeland Care Network is no longer contracted with Cigna. Priority Health is the contracting entity now. Attached below is a Quick Reference Guide we hope will help clarify this new alliance.
Please see the attachments for the recent news from Meridian
Have you been enjoying these monthly updates? Would you prefer to receive them via email? Visit the Bulletins page for your state and fill out our sign-up form to receive the monthly update directly in your inbox!
https://corp.mhplan.com/en/provider/michigan/meridianhealthplan/news/bul...
Provider Bulletins for May 2021:
What’s changing?
Per MDHHS guidance, we’ve updated our policy in 2021 for Medicaid plans to allow members a 90-day Transition of Care window. Providers can submit for Transition of Care authorizations on our website.
What is Transition of Care?
Please see the below Provider Bulletin from United Healthcare for all of the latest news and updates from UHC.
Effective May 1, 2021, Lakeland Care Network has entered into an agreement with McLaren Health Plan for commercial business as well as Medicaid. All Lakeland Care Network credentialed providers are automatically participating for both lines of business. Their commercial plans are called: McLaren Health Plan Commun
Quick reference guide for providers
Starting January 1, 2021, Priority Health and Cigna have entered a Strategic Alliance which means:
• Cigna commercial group members that get care in Michigan can access the Priority Health preferred provider organization (PPO) network.
• Priority Health commercial group members that get care outside of Michigan have access to the Cigna network.
Please see the attachment for further details and Sample ID Cards
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
