MDHHS is hosting a series of CHAMPS 101 Webinars over the next several weeks for interested providers and billers. MI Operations & Regulatory Affairs wanted to share in the event that we’d like to share with any of our provider community .
The current healthcare landscape is rapidly changing. We understand the extraordinary challenges our Members face daily and how difficult it can be to keep up with the most recent COVID-19 developments. With this weekly newsletter, we will provide you the latest news trending in healthcare.
If you haven't visited our site in a while, we have also added a few new focus areas:
Frequently Asked Questions – Monday, August 10
Overview
1. What is Humana announcing?
In September, we’re launching GuidingCare, a new authorization request tool that will replace Clear Coverage and fax requests.
Make sure you're ready
Priority Health has provided their Summer 2020 Provider and Practice Digest with all of the latest Priority Health information.
Please see the attachment for details.
From Priority Health:
A Note from Meridian Health:
The Medicaid Targeted Distribution Funding through the CARES Act application deadline was extended for 1.) Phase 2 general distribution to Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP) and dental providers, and 2.) certain Medicare providers who experienced challenges in the Phase 1 Medicare General Distribution application period. These groups can apply for relief funding through Friday, August 28, 2020 according to the HHS press release issued on July 31.
From the press release:
Physicians, Practice Managers, and Staff,
Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You’re invited to 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.
During this webinar we will discuss:
• VA CCN Overview
• Referrals and Appointment Scheduling
• Providing and Coordinating Care
As the public health emergency continues, and the country slowly starts to reopen, we continue to look for ways to support our customers and the providers who are dedicating their lives to deliver important care.
United Healthcare has provided their latest provider bulletin for August 2020. Please read the attachment for details.
Attached you will find a quick reference guide on Humana and their contacts and resources for offices. Please see the attachment.
UnitedHealthcare recognizes that the persistence of COVID-19 cases across the country continues to have an impact on the healthcare system – both for COVID-19-related care as well as for regular preventive visits. To provide ongoing support to members and providers, UnitedHealthcare is extending many of the COVID-19 temporary program, process and coverage changes through Oct. 22, 2020.
From Humana:
If your office is working with our vendor, Navihealth, following attachment is a streamlined process for a select set of diagnoses for a rapid approval process
From United Health Care:
Please see the attached Collateral that will inform you on how to apply for additional Relief Funds:
Please note even thought this form stated expires 07/20/20, again the state has extended applications till August 3rd 2020.
Again, please see the attachment for details.
Meridian Health has sent a provider educational handout which explains MDHHS guidelines for getting children caught up on their vaccinations. It has some great tips for your providers at their practices and also has safety protocols. Please pay attention to page 4&5 for the immunization specific guidance.
Plese see the attachment for details.
As we shared earlier, on September 14, we’re launching GuidingCare, a new authorization tool that will replace Clear Coverage. Make sure you’re ready to successfully request authorizations this fall by registering for webinar trainings.
What steps do you need to take to ensure success?
The U.S. Food and Drug Administration (FDA) recently requested that prescription metformin ER products manufactured by Apotex Inc., Amneal Pharmaceutics, Granules Pharmaceuticals and Lupin Pharmaceuticals be removed from the market. This is due to a minor impurity. Recalled strengths vary by manufacturer.
Metformin products treat conditions like type II diabetes.
We’re notifying members
Department of Veterans Affairs (VA) has selected Optum as a third-party administrator for Regions Two of the VA Community Care Network (CCN). This contract became effective on January 20, 2020.
Optum would like to host virtual training sessions before the end of August 2020.
In the meantime, the instructions on the VACCN Referral Process is as follows:
Attached are the Meridian Provider educational handouts for the month of July.
Dental Care Information
Last week Priority Health announced that on July 1, 2020, we would return to paying the standard facility-based rate for expanded services provided via telehealth.
Given the investment our providers have made in telehealth, ongoing concerns about patients not visiting provider offices for needed care, and the rapidly evolving COVID-19 situation, we have reversed this decision. We'll continue to pay at the non-facility rate, using the rest of 2020 to review data on telehealth services to inform our future policies.
Attached is the June 2020 Affirmant newsletter. Please read for all of the latest with Affirmant!
The July 2020 UnitedHealthcare Network Bulletin Summary is attached for your reference. In addition, also attached are informational flyers on:
Later this summer, Priorty Health is launching GuidingCare, a new authorization tool that will replace Clear Coverage. The tool will process authorizations for procedures, inpatient, behavioral health, home care, skilled nursing facilities (SNF) and more. This change will not impact the authorization process for eviCore or pharmacy authorizations.
In response to the COVID-19 pandemic, we implemented several temporary changes to support you and your patients.
The purpose of this communication is to give you an update on which of these changes is ending on June 30, 2020, and what’s being extended. We’ve also made a new change for July 1, 2020.
When it comes to hospital visits, we at Priority Health know coverage and costs can be confusing for our Medicare Advantage members. That’s why we’ve developed two education pieces about Medicare Advantage hospital benefits and costs—one for you and one for your patients—that explains how these benefits work in 2020.
Attached you will find the monthly handouts from Meridian for the month of June 2020:
Topics include:
UHC appreciates all the work that you continue to do to care for your patients during the national public health emergency period. As we extend some of our temporary measures, we wanted to share these updates with you.
On May 1, 2020, PH sent a communication about July 1 changes to our commercial formularies (Traditional and Optimized).
Priority Health has made the decision not to move forward with the July 1 formulary change previously planned for diabetes medications Ozempic and Victoza, for our Traditional formulary. This change would have increased the tier and added step therapy through Trulicity for both drugs.
All changes planned for the Optimized formulary will still be implemented on July 1.
Background
NEW: Humana’s 2020 Test Kits for All initiative that has been shaped by the COVID-19 pandemic and its impact on access, willingness and ability for individuals to seek care.
Humana has offered in-home test kits to our members in the past, but the timing and scale of this effort made it important for us to share the information with you so you can support your patients as they receive these kits.
Please refer to the attached documen for details; the document links below will contain multiple documents.
OVERVIEW:
Dear physician and office administrator:
Effective May 1 through Dec. 31, 2020, Humana is waiving copays, coinsurance and deductibles for in-network primary care, behavioral health and telehealth visits. For Medicare Advantage value-based primary care physicians, Service Fund will offset non-capitated PCPs — and reimburse capitated PCPs — for members’ responsibility related to office and telehealth visits with their current PCP or within their PCP practice group. If all members on a PCP’s panel have no cost share, the PCP will see no adjustments.
Webinar opportunity: Closing gaps in care and performing HCC coding in the time of COVID-19
As we navigate this changing landscape, Priority Health wants to make sure your practices are equipped with the knowledge and resources needed to continue closing gaps in care, capturing patients’ full burden of illness, and earning incentive dollars.
We’re offering two sessions:
UnitedHealthcare June Network Bulletin
Front & Center
• COVID-19 Antibody Test Registration Requested (page 5)
All hospital-affiliated and freestanding laboratories, as well as physician practices with in-house laboratories, are being requested to register the COVID-19 antibody test(s) that will be used for our members.
Although the national public health emergency period currently has an end date of July 24, 2020, we know your work is far from over. The following resources will help you quickly reference the effective dates for UnitedHealthcare’s temporary benefit, program and procedure changes related to COVID-19, as well as billing guidelines for services such as COVID-19 testing, treatment and telehealth.
Attached are two handouts supplied from Meridian for May 2020:
Have you been enjoying these monthly updates? Would you prefer to receive them via email? Visit the Bulletins page for your state and fill out our sign-up form to receive the monthly update directly in your inbox!
To support providers with caring for their Humana patients while promoting both patient and provider safety, we expanded the scope, reimbursement rules and channels for telehealth services. We have received many questions and have provided answers to the most frequently asked questions. This FAQ will be updated as we reevaluate our telehealth policy in light of the COVID-19 public health emergency.
Please read the attchemnt for all of the details!
The Claims tool within the Provider Portal now supports Microsoft Word (.doc and .docx) and Excel (.xls and .xlsx) file attachments for appeal and medical record submissions. This is in addition to file types already supported, which include: csv, .pdf, .png., jpg, .jpeg and .txt.
From Humana:
Administrative Update for Providers announcing that Humana will resume medical record requests for claims reviews, effective May 15, 2020.
Distribution of this letter is as follows:
Beginning the week of May 18, 2020, we’ll be reaching out to Medicaid members, or guardians, who are due for immunizations, asking them to schedule these appointments with their primary care providers (PCPs).
We’re also resuming sending reminders for well-child visits. These reminders are sent quarterly via letter or email and ask members, or guardians, to schedule the appointment with their PCP.
Immunization campaign
We’ll be reaching out to two groups of members with phone calls from our customer service team:
From United Healthcare Community Plan:
