News

Please see the attachments for November 2021. 

• Provider Bulletin No 195 – Availity Flyer -   Beginning February 1, 2022, you’ll no longer have access to Aetna Better Health tools and transactions currently located on the Medicaid Web Portal. On Availity, you only need ONE user ID and password to work with Aetna Better Health and other participating payers in your region. 
• Change of Claims Mailing Address -   PO Box 982963 El Paso, TX 79998-2963  

Wishing you a Happy Thanksgiving,

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.

What’s changing

As of Jan. 1, 2022, we’ll launch the following updates to our prior authorizations:

Please read the attached for all of the latest from Priority Health regarding news for physicians and practices!

CIGNA has provided the attachment regarding details of their extension of their policy regarding COVID-19:

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 screening, testing, and treatment in safe settings.

Please see the full attachment below for details.

Priority Health: As health care evolves, we want to continue to partner in the best ways possible with you, our provider network. We evaluated our management of spine services and will retire our Spine Center of Excellence (SCOE) program on Jan. 1, 2022.

What’s changing

We’re moving away from the physical medicine and rehabilitation (PM&R) requirement in our SCOE program. Instead, we’ll use prior authorization focused on nationally recognized criteria developed by InterQual® to manage spine services.   

Aetna Better Health has provided these handouts for your office:

Provider Bulletin:

• Provider Bulletin No 194 – GIC Availity – registered Availity users have access to gaps in care information  

Fax Blast to Medical Practices:

• Change of Claims Mailing Address -   PO Box 982963 El Paso, TX 79998-2963

Please read the materials that United Healthcare has provided for their October 2021 news.

Network News Brief:

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An ABH Update: 

New P.O. Box Address and Vendor for Paper Claim and Claim Correspondence – Effective 11/15/2021

P.O. Box #66215 Will No Longer Be Valid Starting November 15th, 2021.

New P.O. Box

Aetna Better Health of Michigan

P.O. Box 982963

El Paso, TX 79998-2963

September 2021 IInformation from Meridian Health regarding theeir product lines of business:

The Michigan Market temporarily suspending  Authorizations for Discharge to SNF as a response to hospitals being overwhelmed with COVID-19 in Michigan.  This solution will be put into place 9/27/2021 until through 10/28/2021, and then will be reevaluated. 

1. For CMU for MMP, Ambetter and Medicare

There are LIVE provider training sessions thru Availaty. Please see the schedule of training sessions at the link:

https://www.humana.com/provider/medical-resources/claims-payments/making-it-easier

The link to sign up to receive the quarterly newsletters to your inbox instead of having to go out to Humana.com to view them:

Attached are the September 2021 monthly handouts and bulletings from United Healthcare:

• Diabetes Prevention Program Online Workshop
• YMCA Lifestyle Change Program flyer
• Assurance Wireless Lifeline Service
• UHC-CP Healthy Michigan Plan PCP  Assessment  FAQs
• UHC-CP COVID-Vaccine Incentives
• Hepatitis C  Fax Alert

Please read the attached Provider Bulletin from Aetna Better Health:

• Provider Bulletin No 193- Effective 8.1.2021 Coventry Payer ID Number 25133 is No Longer Valid.  Please submit claims for Aetna Better Health of MI members using Payer ID Number: 128MI

United Healthcare has provided this attached information for offices to refer to when dealing with prior authoirzations as well as admission authorizations for Medicaid members.

Please share with your offices. 

From United Healthcare, attached you will find the August 2021 bulletins and informational flyers.

August Network bulletin summary.

Provider Bulletins & MSA Updates

A copy of the Priority Health Medical Policy, for Telemedicine (telehealth), as of June 30, 2021, is attached below.

Please note, all PH Medical Policies are located on the Priority Health Provider Portal, for Provider review and future reference.

All medical policies can be accessed using your office account thru the Provider Portal with Priority Health.  A direct link is:

https://www.priorityhealth.com/provider

Exciting News From the CCM Digital Provider Strategy Team!!!

We are happy to announce that the Humana CCM Digital Provider Strategy team will be holding regularly scheduled live webinars to demo and train providers on the Availity Overpayment Tool.  These webinars will typically be scheduled for the first Tuesday and Thursday of the month at 10:00am or 1:00pm (EST).

For Meridian, information regarding the Payor ID changes that took effect on 1/1/21  is located on the Meridian website under Provider Resources/ Bills and Payments.

For Claims - Professional and Facility call:

Availity Customer Support: 800-282-4548

www.avality.com

Please check the member ID card for the changes which took effect on January 1, 2021

Please see the attachment for a printable handout for your office of these numbers and details.

From Priority Health:

Our goal is to work with our provider partners to optimize health outcomes while providing evidence-based, value-driven care. This is why we’ll move to nationally recognized criteria for our musculoskeletal authorizations starting Jan. 1, 2022.

Why are we making this change?