We’re committed to making it easier for you to do business with us. Our new Precertification web page is one of the many ways we are working to deliver on that commitment. On this new page, you’ll find:
Meridian has provided information sheets on the following topics:
Beginning July 1, 2018, Priority Health will be preferring the use of biosimilar infliximab products over Remicade for commercial, individual and Medicaid products:
Prior to July 1:
Attached is information from United Healthcare regarding their new Dual Complete (HMO-SNP) program. Attached are two resources for your reference. There is a powerpoint which explains the program in detail, as well as a Quick Reference Guide for a handy reference.
UHC has recently made additions to our UHC- Community Plan website. The prior authorization list for our Dual Complete Plan should be easier to find now. See the following links:
http://www.uhccommunityplan.com/health-professionals/mi.html
http://www.uhccommunityplan.com/health-professionals/mi/provider-forms.html
The Lakeland Medical Office Association (LMOA) invites you to attend their April luncheon and meeting.
PROGRAM: Risk Mitigation Best Practices in the Physician Office
Attached is the list of apps that was discussed at the March LMOA presentation on Human Trafficking. The apps listed are ones that the Michigan Human Trafficking Task Force encourages parents and teachers to know about.
Lakleand Care has learned that Priority Health has only loaded some of the midlevels that we have credentialed since September of 2016, which is causing billing issues for our practices and hopsitals. Therefore, for Priority Health patients only, please continue to bill services provided by your midlevel practitioners, under their supervising Lakeland Care physician until further notice.
Lakeland Care Physicians and Advanced Practitioners:
We continuously encourage Lakeland associates and their spouses to have an ongoing relationship with their Primary Care Providers. A new requirement, for Lakeland’s myHealth Wellness Program in 2018, is for participants to have a wellness visit between 1/1/2016 and 10/31/2018. Participants will receive credit based on the Z billing codes for wellness; additional paperwork is not required.
The Lakeland Medical Office Association (LMOA) invites you to attend our March luncheon and meeting.
Sex trafficking does not happen only in big cities. It is an evil that lurks throughout this country and around the world. It’s time to expose the darkness. Come hear a personal story of survival, from Melinda, a human trafficking survivor.
Below is the pdf of the handout that Ellen Berra provided at the Lakeland Medical Office Association luncheon on Wednesday, February 21, 2018.
Effective Jan. 1, 2018, UnitedHealthcare Community Plan of Michigan will begin to serve eligible members in a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete Medicare Advantage ‒ in the following counties: Berrien, Branch, Gratiot, Hillsdale, Tuscola and Washtenaw.
The Health Insurance Claim Number (HICN) is a Medicare beneficiary’s identification number, used for processing claims and determining eligibility for services.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medical identity theft.
MACRA requires that CMS mail out new Medicare cards with a new Medicare Number by April 2019. Medicare will start mailing new cards in April 2018.
North America Administrators (NAA) was one of Lakeland Care's Employer-Specific payors. Lakleand Care providers participated with NAA only for the K&M Machine covered employees. Lakeland Care just received notice that K&M Machine terminated with NAA effective 8/31/17. We are not aware of what payor they might have moved to. Therefore, please ask K&M patients for an updated insurance card.
The Lakeland Medical Office Association (LMOA) invites you to attend our February luncheon and meeting. Please note that this presentation is 1 hour longer than our standard programs.
PROGRAM: Medicare Denials and How to Avoid Them
UHC has recently made two additions to their UHC-Community Plan website. DSNP Prior Authorization Lists and Frequently Used Forms information regarding the Dual Complete Plan should be easier to find now.
The following links will provide you easier access in finding information on the UHC-CP site:
Effective April 2018, individuals age 21 and older who have incomes above 100% of the Federal Poverty Level and have been enrolled in a Healthy Michigan Plan health plan for at least one year without choosing a healthy behavior through a Health Risk Assessment (HRA) may move to the MI Marketplace Option.
Important notes:
CHAMPS Enrollment Enforcement
CHAMPS is Michigan Medicaid’s Provider Enrollment System
– Includes providers participating in a managed care organization’s provider network.
November 2017
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Now there’s a faster way to submit supporting documentation for your pended claims.
MPIE invites you to participate in the following webinars…
The Devil is in The Details: How Documentation Can Make or Break You
February 15, 2018 | 12-1 p.m.
Humana has updated their Pre-Authorization and Notification Lists for 2018. Please visit the following link for more information on these important updates:
https://www.humana.com/provider/support/claims/pre-authorizastion
On January 1, 2018, Lakeland Care Network welcomed a new commercial contracted payor - SecureOne.
SecureOne contact information is as follows:
Meridian Choice is a new commercial product that is offered on the Health Insurance Exchange. All Lakeland facilities and all Lakeland Care credentialed providers participate with this new product. This contract became effective October 1, 2017.
All Lakeland Care providers are now required to access CHAMPS to register in the Michigan Medicaid program. Registering in the Michigan Medicaid program does not require you to be a Medicaid FFS provider. The State of Michigan is requiring this change in accordance with the 21st Century Cures Act.
Lakeland Care Network has added a couple of newly contracted payors to our panel for 2018.
Secure One became our most recent addition to our Commercial Panel. This contract became effective 1/1/2018.
The Lakeland Medical Office Association (LMOA) invites you to attend our January luncheon and meeting.
Join us for a FUN, interactive insight into some of the latest features, trends and information related to Epic. This presentation pertains not only to those who use Epic as their EHR everyday - but to all practices in the Lakeland Care Community who want to learn more about the latest trends and best practices in healthcare technology, security and communication. IT Topics to be discussed are:
Lakeland Care announced at the Annual Payor Conference on 10/18/17 that the Lakeland Care Network had issued a termination notice to McLaren Health Plan on 9/11/17 indicating de-participation from their Medicaid Health Plan effective 12/31/17.
Effective January 1, 2018, our Provider Helpline representatives will direct callers with claims questions to our automated phone system or their provider account on priorityhealth.com. This change should reduce the wait times for speaking to a representative.
Our representatives will still assist with all other concerns, including those regarding claim denials.
Effective December 1, 2017 Priority Health will utilize a select, limited group of pharmacies as preferred for all outpatient Medicaid prescription fills.
In our Medicaid service regions (West Michigan and Southwest Michigan) there will remain approximately 220 approved pharmacies where patients can have prescriptions filled. Many large retail stores will continue to be in the Priority Health Medicaid pharmacy network, such as:
· Walmart
· Meijer
· Walgreens
· Costco
· SAM’s club
Our online accounts and self-service automated phone system allow you to have 24/7 access to information about claims, benefits and authorizations. One of the most popular features of these tools is being able to look up simple claim information, including check numbers, amount applied to a deductible or coinsurance, or the amount being paid to you.
To reduce our hold times for our provider call center, we’re going to direct those who have basic claims questions to self-service tools.
All current and new UnitedHealthcare Community Plan Michigan Medicaid providers, including out-of-state providers, are now required to access CHAMPS to register in the Michigan Medicaid program. Registering in the Michigan Medicaid program does not require you to be a Medicaid FFS provider. Effective January 1, 2018, failure to enroll in CHAMPs will result in claim denials.
Please see the attachment for further details.
Thanks to all who spent the afternoon with us last week at the annual Lakeland Care Network Payor Conference. We hope it was a valuable day for you and your office or department. Attached are presentations for your reference.
We greatly appreciate your patience as we continue to optimize the eviCore experience. As you know, we are currently in the "educate and pay" phase, which gives you an opportunity to become more familiar with eviCore's clinical criteria. During this time we are also diligently working with eviCore to improve operational challenges.
Our process remains the same
As a reminder, our processes communicated on 8/22/17 remain the same, and will continue through the end of the calendar year:
The State of Michigan is offering funding for integrating the new Michigan Automated Prescription System (MAPS) with the
You get them all the time.. the faxes from Humana asking your office to update your provider information with Humana in accordance with federal provider directory standards. Good news! If your providers are part of the Lakeland Care Network, you do not have to respond to these anymore. Lakeland Care will take care of that for you! If you are an LMP practice, you don't need to send them to the Medical Staff Office either.
Educate and Pay Program
As we continue to work with eviCore to identify solutions and address issues we have faced since the program implementation this summer, we are moving into a new phase, the Educate and Pay program. With the new program there are new communications you will be receiving from eviCore and there are new actions you will need to take.
The Lakeland Medical Office Association invites you to attend our September season kick-off luncheon and seminar.
Program: Enhancing the A/R Management Cycle and Reducing Bad Debt
The implementation and launch of eviCore was meant to provide our provider partners a seamless, evidence-based tool that helps provide your patients the right care at the right time - ensuring the best health outcomes.
Priority Health has suspended some criteria for spine/joint procedures.
The eviCore prior auth tool went live in June for all in-network musculoskeletal and spinal procedures, genetic testing, and advanced diagnostic imaging. Since the launch, Priority Health has identified some technical issues that need to be resolved to follow the guidelines originally outlined.
