Some important AETNA news updates
1. Yesterday evening Aetna announced temporary changes to reduce requirements for prior authorizations for post-acute care and long-term acute care hospital admissions (please see details attached).
UHC Leadership has requested to keep in mind that Medicaid members cannot be charged co-pays or services fee’s when providing telehealth services. These are listed as covered benefits with Fee Schedule’s built for payments.
Attached is the MDHHS fee schedule for your reference.
The MDHHS fee schedule site for your reference and is also listed:
https://www.michigan.gov/documents/mdhhs/Telemedicine_012020_678209_7.pdf
We understand that it’s a confusing time. Right now, you need all the resources and information you can get. We’re working to keep you updated so you can focus on keeping the country healthy and safe.
We're actively working to monitor the new Coronavirus disease—COVID-19—and its impacts to make sure we provide our members the care they need when they need it while supporting our providers.
Rest assured that we have business continuity plans in place. We’ll continue to serve you and your patients online and over the phone.
This is a rapidly developing situation. We’re updating information and policies frequently.
Attached you will find the monthly handouts from Meridian for the month of March 2020:
Topics include:
Attached is Cigna's COVID-19 Interim Billing Guidelines for Providers. This billing guidance document will continually be updated.
From Humana:
MeridianRX, the pharmacy benefit manager for MeridianHealth (Meridian), is dedicated to helping members receive the care they need during the state of emergency that was declared regarding COVID-19.
During the state of emergency, Meridian will allow an override code of submission clarification 13 to override refill-too-soon and pharmacy out-of-network rejections for patients managed through MeridianRx
Please see attachement for more detailed information.
Aetna announcement effective March 6 on zero co-pay telemedicine visits for any reason for 90 days, please see below excerpt. Also attached is Aetna’s updated telemedicine policy that was new 1/1/1/20 that had coverage details and CPTs and has been updated to reflect this March 6th update. 2nd attachment is the Aetna Covid Press release. This announcement also is posted and available to providers on NaviNet and Availity with links to policy and press release as well.
From United Healthcare:
As with any public health issue, UnitedHealthcare will work with and follow all guidance and protocols issued by the CDC, state and local public health departments regarding COVID-19. The health of our members and the safety of those who deliver care are our top priorities. We’re taking action and providing resources to support our members and providers during this challenging time.From Unite
REMINDER: DESIGNATE YOUR PRIMARY CARE PROVIDER
The eviCore healthcare web portal is the most efficient way to initiate requests for prior authorization and check the status of an existing request. The self-service web portal is available 24/7, enabling you to initiate and review authorization information at your convenience.
To ensure you have the tools to be successful using our web portal, Meridian invites you to join one or more of the orientation sessions listed below. Whether you’re new to the web portal, or are an experienced user with questions, these sessions can help you maximize your web portal experience.
Attached you will find the monthly handouts from Meridian for the month of February 2020:
Topics include:
In an effort to streamline the authorization process for the MeridianComplete services managed by H3, providers can submit requests directly to H3/Innovista via the submission options below.
You’re invited to Veterans Affairs Community Care Network Overview educational session.
Join us for one of the following virtual one hour educational presentations to learn more about VA CCN, treating Veterans and doing business with VA and Optum. During this webinar we will discuss:
Registration is required and space is limited.
At UnitedHealthcare, we’re doing all we can to simplify the health care system for everyone.
Point of Care Assist™, adds real-time patient information —including clinical, pharmacy, labs, prior authorization, eligibility and cost transparency — to your existing electronic medical records (EMRs) to make it easier for you to understand what patients need at the point of care.
Providers play an integral role in the care teams that support our dual-eligible special needs members. That’s why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who routinely see PriorityMedicare D-SNP patients are trained on our Model of Care. Our Model of Care is a quality improvement tool that ensures the unique needs of our D-SNP members are met and describes the processes and systems we use to coordinate their care.
Attached you will find the monthly handouts from Meridian for the month of January 2020:
Topics include:
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Dear Physician or Administrator:
As Humana continues to make improvements to the Service Fund system, we want to share these improvements with you.
Bulletin Board System (BBS) Report Archive – BBS data reports older than 12 months will be archived. The archiving will process through the end of 2019 and will be finalized beginning January (PE20200101). The data reports up to 10 years old will remain in the archive. Requests for archived data reports may be sent to servicefund@humana.com.
LCN recently hosted a speaker event where the following topics were discussed:
Part 1: VA Contract with Optum
Department of Veterans Affairs (VA) has selected Optum as a third-party administrator for Regions Two of the VA Community Care Network (CCN). This will go live on January 20, 2020. UnitedHealthcare representatives will go over the new VA referral process as well as how claims are submitted for reimbursement. Information will also be provided to take back to offices for reference.
The PH provider portal has been updated to allow you to ask questions and add an attachment when sending a message in our Claims tool for coordination of benefits, third party liability, claim edits and other claims questions.
They have removed the dropdown option for coordination of benefits, third party liability, claim edits and other related claim questions from Secure Mail. These options are now available in our Claims tool in addition to adding an attachment.
Where to find this new feature in the Claims tool
Lakeland team members and their covered family members have a new co-pay structure for 2020!
PCP co-pays are remaining at $30, but the co-pay for a specialist visit has increased from $30 to $45.
Please make sure your front desk staff is aware of the change. If you are seeing anything different while looking at Real Time Eligibility, please let us know at (269) 927-5207 or (269) 985-4474.
Effective 1/1/20, Lippert Components is a new employer group who has access to the Lakeland Care Network. This employer group has been added to the LCN Listing of Contracted Payors under the "Employer-Specific Payors" section. The payor that Lippert has chosen to use is Key Benefit Administrators. Therefore, all Lakeland Care Network providers are considered participating for all Lippert Components covered members.
Medicaid claims that do not meet the Michigan Department of Health and Human Services (MDHHS) billing requirements are being rejected as of Jan. 1, 2020.
Based on the feedback we received at the Payor Conference in October, Lakeland Care Network has planned this special breakfast meeting and invites you to attend so we can bring you information on the new VA Contract with Optum, along with very helpful information directly from Priority Health Claims Department. This presentation would be helpful for office/practice managers, billing staff, and appeal team members.
In an effort to streamline the authorization process for the MeridianComplete services managed by H3, providers can submit requests directly to H3/Innovista via the submission options below.
LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.
The Lakeland Medical Office Association invites you to attend our January luncheon and seminar.
Program: De-Escalation Techniques for ‘Bad’ Behavior in Physician Offices
Effective Jan. 1, 2020, substance use disorder intensive outpatient services will no longer require authorization or clinical review for commercial members.
Why we’re making this change
We’re removing the authorization requirement to improve members’ access to substance abuse intensive outpatient services to ensure they’re able to get the right care at the right time.
How services will be monitored
Attention offices! The preventive lab benefits for Spectrum Health Lakeland (SHL) plan members has changed quite a bit for the new 2020 plan year.
Please refer to the attached Preventive Healthcare Guidelines publication from Priority Health.
In 2019, Spectrum Health Lakeland (SHL) was under their own pharmacy benefit plan with Express Scripts.
In 2020, pharmacy benefiit coverage will still be processed through Express Scripts - but under Priority Health's plan.
See the attached FAQ for more pharmacy benefit information. Be advised that the formulary has changed from 2019 to 2020.
Attached you will find the monthly handouts relating to the following topics:
Please visit the Meridian website for more detailed information.
On Jan. 1, 2020, The Centers for Medicare and Medicaid Services (CMS) is changing its payment system for home health agencies for original Medicare.
The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration’s Clearinghouse rules are effective January 6, 2020. The FMCSA Clearinghouse is an electronic database that will contain information about commercial motor vehicle drivers’ drug and alcohol program violations. 49 CFR Part 382, Subpart G
For those of you who asked, here is the electronic version of Mary Ellen Duffy's November 20th presentation on How to Aggressively Manage your Revenue Cycle.
(click on the news article title to see the attachment)
Effective Feb. 1, 2020, all commercial group and individual plans will cover counseling services as a preventive service, for pregnant and postpartum women identified as at-risk for depression.
When preventive, counseling services will be covered at 100% ahead of deductible.
Why are we making this change?
Thank you to all who spent the day with us back in October at the Lakeland Care Annual Payor Conferece. We hope it was a valuable day for you and your office. As promised, attached are the presentations for your reference.
(click on the news article title to see the attachments)
MeridianComplete (Medicare-Medicaid Plan) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective January 1, 2020. This program is designed to work collaboratively with providers in promoting patient safety through the practice of high-quality and cost-effective care for MeridianComplete members undergoing musculoskeletal surgical procedures.
Effective January 5, 2020, Optum UnitedHealthcare will be the administrator for the Veterans Affairs Community Care Network (VA CCN). Attached you will find an invitation to educational sessions available to you and your Staff during the month of December. Registration is required as space is limited.
We heard you, and we're making an exciting change to our online provider portal to help you work with us faster and easier. As part of our commitment to reducing your hold time when you call us and giving you more of the information you need at your fingertips, front-end rejected claims and reasons are now available on our provider portal.
Where to find your front-end rejected claims
