Aetna Medicare member IDs are changing from the alpha numeric mix of MEB or MED**** to 12 digit numbers starting with ‘10’. See below on the info/details and ID card examples
Member ID numbers are changing
- Member ID numbers are 12 digits and start with ‘10’
- Members will be mailed new ID cards
If a claim for a 2021 date of service is submitted using an older 2020 HMO member ID, claims logic is in place to evaluate the member ID and the DOS and redirect the claim to the appropriate claims platform.
Aetna Better Health has provided these flyers as their monthly updates and NEW fax numbers for offices:
Provider Bulletin No 182 – ABH MI Prior Authorization Fax Numbers – effective 1.29.2021
There are three websites offered by Ambetter / Meridian Health as resources to providers and their offices:
Medicaid – Mhplan.com
Ambetter – ambettermeridian.com
Please see the attached fax notification that is going to be sent to offices regarding the prior authorization vendor change for MeridianHealth (Medicaid) and WellCare (Medicare). This change is going to go into place effective 4/1/21.
Please read the attached newsletter for February 2021 from UHC for all of the latest details.
A preview: To ease the administrative burden you may be experiencing in submitting COVID-19 vaccine administration claims for Medicare beneficiaries, UnitedHealthcare has made it easier for you to find a member’s Medicare ID number. We also have a tool to help members find state and county health department resources on FDA-authorized vaccines, as well as materials you can use to encourage your patients to wear masks – a critical step in reducing the transmission of COVID-19.
The dates for our 2021 behavioral health collaborative care (BHCC) meetings are now available. Provider organizations are required to attend at least three Priority Health-sponsored BHCC meetings as part of eligibility requirements for the BHCC incentive.
Other BHCC eligibility requirements include:
- Have PCMH recognition in the program year
- Attend at least one BHCC learning event in the program year
As we continue to monitor the status of COVID-19 cases and review procedure data in the 22 states listed below, we are implementing changes to authorization requirements.
Humana is reinstating authorization requirements for Medicare Advantage and commercial members for skilled nursing facilities (SNFs) for dates of service on or after March 1, 2021, in these states:
If there are questions regarding veterans and their coverage, please visit the site below for the latest updates:
Information to sign up for Centine (Meridian Health) Monthly Provider Updates can be found by registering at: mhplan.com
Currently, there also are Complete and Ambetter independent websites that providers could register for access to those websites and look for any current updates,
To access Ambetter website: ambettermeridian.com
Cigna has entered into a new Strategic Alliance with Priority Health. This partnership enables us to leverage
the best capabilities of both organizations, and deliver a health care experience in Michigan’s Lower
Peninsula that is more predictable and simplified for providers and customers.
What you should know
From Humana --
An important message regarding Humana’s COVID-19 response: ADMINISTRATIVE UPDATE Jan. 20, 2021
Like you, we are concerned with the unprecedented surge of COVID-19 cases in Arkansas, Colorado, Delaware, Idaho,
Indiana, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma,
Pennsylvania, Texas, Utah, Virginia and West Virginia. We strive to understand the unique challenges different states face
and determine how we can help.
Gaishin Manufacturing is one of Lakeland Care's employer-direct contracts that utilize Claims Choice as their payor. Last year your office was participating with Claims Choice only for two employer groups: Gaishin Manufacturing and Supreme Casting.
Stay informed about COVID-19
Latest COVID-19 news from UnitedHealthcare – Updates to temporary COVID-19 treatment and prior authorization provisions, reminders on vaccine administration reimbursement
Thank you for all the work you continue to do to care for your patients during this time. We are sharing the following updates to help you deliver care and be reimbursed for the services you provide:
Please review the attached documents sent to us from Aetna Better Health for January 2021:
- FAQ: COVID-19 Vaccine Public FAQ
- MI COVID-19 Vaccination Prioritization Guidance
- Bulletin: MSA-20-75-Vaccine-New
Since the COVID-19 pandemic began, we have 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.
Attached you will find the United Healthcare Network News Bulletins and the UHC Telehealth update for January 2021.
Humana is providing these documents as a resource for practices:
- Humana Claim payment Inquiry Resolution Guide
- Humana Tools and Resources for Physicians and Healthcare providers
- Availity Overpayment Tool: How to Access the Recorded Training Session
The Centers for Medicare & Medicaid Services (CMS) published the 2021 Medicare Physician Fee Schedule (PFS) final rule on Dec. 1, 2020, expanding Medicare-covered telehealth services to similar services already covered under the Medicare program. Please note:
Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.
What you need to know
Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.
Examples of fraudulent requests:
An Update from Priority Health:
As COVID-19 vaccines begin to be more widely distributed in our communities, we’re sharing information on billing and reimbursement for the vaccines and administration.
You should not collect any member cost share, such as copays, for first or second doses of COVID-19 vaccines or administration of the vaccine.
UnitedHealthcare is extending the temporary suspension of select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide through Jan. 31, 2021. The temporary suspensions are effective from Dec. 18, 2020 through Jan. 31, 2021. (They were previously set to end on Jan. 8, 2021.)
Humana has provided us the attached Power Point presentation regarding their NEW authorization process -- Cohere. This process began on 1/1/2021.
Please read the details in this attachment about how to submit a request, the clnical review process, peer to peer consults, and many more details regarding this new authorization system.
Please read the attachment for the latest news from Priority Health!
In addition from Priority Health:
The 2021 PCP Incentive Program (PIP) manual is finalized and available for download. Visit 2021 PCP Incentive Program Manual (priorityhealth.com) to view.
Overview of 2021 finalized PIP manual
2021 new measures
Please read the informational attachments for the latest from United Healthcare on COVID-19, Tele-health, The Administrative Guide for 2021, and much more in 2021.
Also, please connect with this link to sign up for future emails from UHC: Please visit: UHCprovider.com/subscribe to sign up!
Since the COVID-19 pandemic began, CIGNA has delivered timely accommodations to providers and customers, and ensured that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.
Please read the attachment for details on vaccines, treatments and extended coverage accommodations.
Please read the December 2020 issue of the United Healthcare Provider News Brief for all of the latest information from UHC..
In addition, COVID -19 authorization process requirement has been postponed until 01/04/2021; please see the attached document for further details
To remain in compliance with Medicaid billing requirements, on December 14, we’re moving to up-front claims rejections that have the missing or incorrect information listed below. Previously these were warnings.
The new upfront rejections included:
Attached are the Meridian Provider educational handouts for the month of December 2020. There is also important information on Ambetter which takes effect on 1/1/21. This is a Centene Ambetter brand change from Meridian Choice/Comm/HMO effective in 2021
To continue to support you and our members as COVID-19 cases rise in our communities, we’re extending many temporary changes into 2021. Get the complete list of temporary changes and their expiration dates.
In support of easing administrative burden during this pandemic, we (Meridian) are reinstituting many of our operational changes from the spring. If there’s anything we can do, please let us know and we'd be happy to champion it through the organization.
Humana has provided the first FAQ related to the COVID vaccine, and it will be updated weekly as new information is available.
Virtual Office Advisory
Thursday, December 17, 2020
Noon – 1 p.m. EST
Join us for our upcoming December Virtual Office Advisory webinar and learn about:
- How to credential nurse practitioners and physician assistants
- 2021 E/M billing changes
- How to review a claim using our claims inquiry tool
- Supporting you and your patients during COVID-19 in 2021
Cigna has entered into a new Strategic Alliance with Priority Health. This partnership enables us to leverage the best capabilities of both organizations, and deliver a health care experience in Michigan’s Lower Peninsula that is more predictable and simplified for providers and customers.
Cigna members will begin accessing medical care through the Priority Health network effective 1/1/2021
Please see the attached United Healthcare Network Bulletin regarding 2021 updates and changes to programs and policies.. Additionaly, please read the monthly handouts and bulletin..
As partners with you in your patient’s health, we want to keep you informed of the various member programs happening now through the end of the year, with the goal to help keep Medicare and Medicaid members, your patients, safe and healthy with more resources and support in addition to their doctor visits.
Like you, we are concerned with the unprecedented surge of COVID-19 cases in Michigan. We strive to understand the unique challenges different states face and determine how we can help.
In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial members for the entire state of Michigan through Dec. 31, 2020. NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning.
- Charting Our Course Together in a New World
- Don’t Drop the Ball on Infection Control: Looking Beyond COVID-19
- The Quandary of COVID Disclaimers