News

The April 2020 UnitedHealthcare Network Bulletin Summary is attached below.

The entire bulletin can be found on www.UHCprovider.com > News and Network Bulletin  located at the bottom of the page.

Humana to Waive Medical Costs Related to Coronavirus Treatment

Costs waived whether care is virtual, in a doctor’s office or hospital setting

Also, please see the link below for any updates for our COVID-19 information. 

COVID-19 update for providers from Priority Health

Information about COVID-19 is changing rapidly, and we know it’s important to stay updated. We’ll send weekly email updates during this situation.

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

COVID-19 update for providers

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 is Cigna's COVID-19 Interim Billing Guidelines for Providers. This billing guidance document will continually be updated.

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.

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

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.

The Lakeland Medical Office Association invites you to attend our February luncheon and seminar.  

Program:  Crucial Conversations – Living & Working with Emotional Intelligence

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:

•  VA CCN Overview
•  Referrals and Appointment Scheduling
•  Providing and Coordinating Care
•  Medical Documentation Requirements and Claims
•  Where to locate additional resources

Registration is required and space is limited.

2020 PriorityMedicare D-SNP Model of Care provider training is now available

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.

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.

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

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.

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.

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

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.

Attached you will find the monthly handouts relating to the following topics:

• Tobacco Cessation
• Osteoporosis Management in Women and Preventing Fractures
• Persistence of Beta-Blocker Treatment After a Heart Attack
• Appropriate Screening for Prostate Cancer
• Prescribing Antipsychotic Medications

Please visit the Meridian website for more detailed information.