News

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.

The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration’s Clearinghouse rules are effective January 6, 2020. The FMCSA Clearinghouse is an electronic database that will contain information about commercial motor vehicle drivers’ drug and alcohol program violations. 49 CFR Part 382, Subpart G

Effective Feb. 1, 2020, all commercial group and individual plans will cover counseling services as a preventive service, for pregnant and postpartum women identified as at-risk for depression.

When preventive, counseling services will be covered at 100% ahead of deductible.

Why are we making this change?

MeridianComplete (Medicare-Medicaid Plan) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective January 1, 2020. This program is designed to work collaboratively with providers in promoting patient safety through the practice of high-quality and cost-effective care for MeridianComplete members undergoing musculoskeletal surgical procedures.

We heard you, and we're making an exciting change to our online provider portal to help you work with us faster and easier. As part of our commitment to reducing your hold time when you call us and giving you more of the information you need at your fingertips, front-end rejected claims and reasons are now available on our provider portal.

Where to find your front-end rejected claims

Priority Health is making changes to their 340B program based on your feedback. PH will now review 340B claims post-payment, which means that they will review paid claims quarterly.

What can facilities expect?

The first post-payment review will begin in December 2019 for providers enrolled in the 340B program. We may contact facilities for a list of drugs purchased through the 340B program or for specific exclusion criteria.  

Does the 340B program apply to Medicaid claims?