News

InterQual, managed by Change Healthcare, is experiencing a national outage. This outage impacts prior authorization processes for providers and payors across the country.

The issue with Medicaid edit 5167 incorrectly front-end rejecting claims, first discovered on May 23, was resolved on May 30. All impacted claims have been reprocessed.

United Healthcare has shared their Network News updates for June 2023

Priority Health is offering an one hour webinar on thursday, June 8, 2023 at noon on the topic of Virtual Office Advisory.

This issue of BCN, Partners in Care, introduces BCN’s Chief Medical Officer Peter T. Graham, M.D., and focuses on how we’re working to improve the experience you and your providers have with us and collaborate with you to improve your patients’ health care experience.

Priority Health is experiencing an issue with their Medicaid claims front-end rejecting for “Claim Type Requires a Referring/Ordering NPI” when they shouldn’t.  Priority Health teams are working to find the root cause and fix the issue as quickly as possible. Until then, they recommend you don't rebill those claims!

On Jan. 1, 2023, CMS released two new care management codes for chronic pain management – G3002 and G3003 – which allow providers helping chronic pain patients to bundle key services and bill monthly rather than a’ la carte.

An update from Priority Health on a series of medical policies.

A summary of the United Healthcare May 2023 Network News

From Humana: In a continued effort to optimize care for our members and ensure prompt delivery of quality DME, Humana has entered into enhanced partnerships with DME provider— Rotech. Effective July 1, 2023.

Blue Cross Blue Shield of Michigan and Blue Care Network have implemented a monthly data feed to inform you of your group’s assigned BCN AdvantageSM members who are eligible for the Landmark Health high-intensity in-home care program for members with multiple chronic conditions.

This newsletter is for physicians, specialists, clinicians and office staff to deliver the latest news, resources and administrative information to support them in the care of their patients.

On June 1, 2023, the state of Michigan will restart full eligibility reviews for D-SNP, Healthy Michigan and Medicaid members. Medicaid redetermination is the process by which Medicaid members must reapply for their Medicaid benefits and prove they qualify for Medicaid.

Aetna Better Health is excited to announce that we’re moving to Phase 2 of the Availity Appeals Enhancement Pilot. What we need are Providers (office staff), that are willing to participate in the Pilot. The above attachment gives a high level overview of what the Enhancement is about.

We want to make sure you stay informed about your patients and practices who are offered the opportunity to receive a free pharmacogenomics test as part of BCN’s new Blue Cross Personalized MedicineSM program. Please sign up to receive regular reports by emailing RXQualityPrograms@bcbsm.com with the names and email addresses of desired recipients for your group.

Medicaid redetermination is the process that states use to ensure that Medicaid enrollees continue to be eligible for Medicaid coverage. Typically, redetermination happens once a year; however, the rules changed during the pandemic.

Lakeland Care Network (LCN) was recently informed by Humana that certain taxonomy codes are no longer accepted by their Medicare product as of 10/31/2022. Per Humana, providers with the attached taxonomy codes are no longer eligible for Medicare reimbursement. 

The PHE allowed for member cost share flexibility within their health plan for COVID-19 related claims. The end of PHE will mark several cost share and coverage changes for testing, vaccines and more.

The Second Quarter 2023 issue of Cigna Network News is now available. Network News is easy to navigate and it is easy to find what you’re looking for, including policy and network updates, as well as industry tools and resources.

PHPs new partnership with Valenz Health for prior authorization services goes live May 1, 2023.

A new employer group, AZO Services, now has access to the Lakeland Care Network through our Confinity contract. Effective May 1, 2023, AZO Services will be using the payor Auxiant.

Attached you will find the monthly updates for April 2023 from our partners at UnitedHealthcare.

• Medicaid changes to dental  coverage effective April 1, 2023
• UHC Network News for April

Humana has made significant changes to their commercial products in regards to preauthorization and notifications in 2023.

On April 1, 2023, our payment reference IDs that accompany claim and capitation payments will change.

As Michigan’s Prior Authorization Reform legislation (SB 247 / PA 60) goes into effect on June 1, 2023, we’ll implement new requirements for some of our prior authorizations to help ensure timely, appropriate care for our members, your patients.

An outline of the new clinical edits for professional and facility claims.

As you may know, in April 2022, Governor Whitmer signed the prior authorization reform bill, Public Act 60 (PA 60), into law. We’re excited that this legislation supports streamlining how we work with each other, making it easier for our members – your patients – to get the care they need when they need it.

Changes to our National Precertification List (NPL) applying to both our commercial and Medicare members.

We have received multiple questions regarding the impact the Blue Cross Personalized Medicine℠ program has on your annual Product Exhibits. As a reminder, this is the program that uses genetic testing to personalize medication treatments.

Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You are invited to attend a 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.

Now that claim reconsiderations and appeals must be submitted electronically, we want to help make sure you have the how-to information you need to manage them with ease.

Corewell Health South's Compliance team's presentation to the LMOA membership.

Blue Care Network Qualification Form must be submitted online within the BCN Health e-Blue℠ application.

We’re reissuing new ID cards to our commercial members to update the pharmacy processing information on the back of their card. This change will take effect April 1. Members will receive their new cards between March 31 and April 28.

We’ve partnered with Livongo to offer a digital diabetes management program to your commercial fully funded patients with type 2 diabetes. This program will strengthen the care you provide and offer the extra support your patients need to manage their health.

The latest monthly update from United Healthcare

Recently fixed errors for certain services

Blue Care Network mailed additional letters at the beginning of March 2023, to primary care physicians and prescribers with BCN patients who are being offered the opportunity to receive a pharmacogenomics test as part of BCN’s new Blue Cross Personalized Medicine℠ program.

Informational handouts from Humana

Informational handouts from Humana