To our offices,
There are upcoming significant changes that Meridian has informed us about.
Please open the below attachment and read the detailed information regarding these significant changes by the Meridian system being implimented on April 1, 2022.
Please feel free to print and share the attachment with your fellow teams.
Thank you!
United Health care wants to make offices aware of a recent change that will impact your current process. As of December 1, 2021, providers for most plans are no longer required to submit observation notification after a patient has been discharged home from observation level of care.
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ABH of Michigan has been notified by MDHHS of claims that have rejected for "Provider Type Not Allowed for Referring/Ordering/Attending NPI"
Claims releated to the rejections received by the health plan will be recovered and corrected claims will need to be submitted.
Please review claims billing guidelines to ensure your claims are billed properly.
Please see the attahment for all details from ABH.
Dear Medical Care Group Business Administrator:
Priority Health has decided to cancel the March 2022 launch of Clinical+ due to feedback we received from providers who tested this tool for us.
Why are we making this change?
Due to the persistence of COVID-19 cases in your area, UnitedHealthcare is extending and expanding the temporary program provisions outlined in the attachment below. This announcement is applicable to all in-network hospitals and skilled nursing facilities (SNFs) in Michigan statewide.
SAVE THE DATE!
Thursday, February 24th, 2022
1:00pm – 3:00pm CST
Priority Health has scheduled the 2022 Behavioral Health Collaborative Care meetings. Practices interested in earning the incentive for this measure should plan to attend at least 3 out of 4 quarterly virtual meetings to discuss collaborative care activities, share best practices and discuss barriers to implementation.
Between 1/1/2022 and 2/28/2022, prior authorizations are NOT required for post-acute stays at skilled nursing facility, long-term acute care hosipital or nursing facility.
Please read the full attachment for the full details of the policy update.
HAP has shared the latest monthly handouts for your offices:
Please see the attachments for all of the details:
Please see the attached document stating the prior auth waiver has been extended to 2/4/2022.
PH has provided a resource to our offices that may help navigate and answer typical questions that arise during the normal day-to-day operations in your offices.
Please read the attachment and even print this handy resource.
Since the COVID-19 pandemic began, Cigna has taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 diagnostic services, testing, and treatment in safe settings.
WellCare/MeridianHealth’s Quality Improvement Department is hosting an exciting opportunity to learn about Risk Adjustment and Clinical Documentation. This free, virtual webinar will help you improve patient documentation and coding practices which will ensure patients have access to adequate resources and quality care. This webinar is ideal for providers, nurses, and anyone in your practice to who codes patient diagnoses.
Please see the attached document for all of the highlights regarding updates from Prioirty Health.
You may need to resubmit rejected claims for your Medicaid patients who also have other insurance.
Due to the persistence of COVID-19 cases in your area, UnitedHealthcare is extending and expanding the temporary program provisions outlined below. This information and dedicated support resources are being communicated directly to you as one of the impacted hospitals or facilities.
Hello Hospital Partner-
COVID is surging across the US with many providers requesting assistance because of the rise in cases and shortage of staff. Aetna recognizes the need to move to a National SNF Waiver effective today, January 6, 2022 through January 31, 2022. The attached communication has been updated to reflect the expansion.
Since the COVID-19 pandemic began, Cigna has taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 diagnostic services, testing, and treatment in safe settings.
Reinstituting and extending interim accommodations
With the recent surge of COVID-19 cases resulting in increased strain on providers, we are making a number of accommodations to support you.
From our Parrtners at Humana:
Michigan - Humana is suspending authorization requirements for skilled nursing facilities (SNFs)for Medicare Advantage and commercial fully insured members discharging from hospitals in the state of Michigan through Jan. 16, 2022. 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.
Please share with your team and providers.
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That’s why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who treat our PriorityMedicare D-SNP™ members are trained on our Model of Care.
Dear BCN Medical Care Group Business Administrator:
Effective Jan. 1, 2022, your pharmacy paid claim files will identify if a pharmacy claim was processed by Express Scripts® or OptumRx®. Look in the claim number field.
From our partners at AETNA:
Hello Hospital Partner- an update that only applies for acute hospitals and SNFs
Attached noticed was supposed to go out to hospitals but in case you haven’t received or info didn’t make its way to you yet I wanted to make you aware that Aetna has liberalized Initial SNF Auths from Acute Care Hospitals since 11/22/21 and goes through 1/10/22. I attached a notice if need to share as has all the details. Please share as needed within your system.
Priority Health has made a few updates in prism this week.
Our teams are continuously enhancing prism to make it even better. In this week’s release, we’ve made the following enhancements:
Appeals
On the appeals page, we renamed the Auth Appeal button to Pre-Claim Appeals. Instead of going through the legacy Secure Mail tool, you’ll stay within prism to fill out the required information and attach files for pre-claim appeals.
Enrollments & Changes
Dear Physician Organization and Medical Care Group Business Administrator:
The Oxford school incident has had a significant impact on our members. Blue Cross Blue Shield of Michigan and Blue Care Network have been working with first responders to assist our members. We recognize that the shock waves of this tragedy have been felt across the state and combined with the approaching holiday season and the ongoing pandemic, your physicians likely have patients who could use behavioral health services.
1) Starting January 2022, CMS is resuming the standard sequestration of 2%.
What’s changing
Bill 1868 extended the CMS sequestration suspension through Dec. 31, 2021 due to COVID. Based on current statute, CMS will resume standard sequestration reductions beginning with the January 2022 payment for Medicare Advantage.
What you need to do
Appendix Bulletins
Attached you will find information on the following topics from Meridian Health:
Please see the attachments for November 2021.
Wishing you a Happy Thanksgiving,
From Meridian Health:
The MHP Meridian auth portal is down for submitting auths therefore for Medicaid auth request you will need to fill out the form attached and fax directly. When looking up the CPT fax to the department that is listed or refer to the bottom of the form for instructions.
There is no update at this time from Meridian as to when the portal will resume function.
In July, Priority Health shared plans to move musculoskeletal (MSK) services to InterQual® criteria. In addition, there are a couple other changes happening Jan. 1, 2022.
As of Jan. 1, 2022, we’ll launch the following updates to our prior authorizations:
What’s changing?
We’ll start paying for Medicare members’ vaccines
On January 1, you should begin billing us for the COVID-19 vaccine and its administration for all Medicare members enrolled in our plan. We’ll post the appropriate CPT codes in our Medicare fee schedules (login required).
Please read the attached for all of the latest from Priority Health regarding news for physicians and practices!
