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:
In honor of Risk Management Week, Michigan Professional Insurance Exchange is extending this special invitation to you to join us for three separate webinars, June 16-18 for the 2020 Regional Education and Networking Meeting. Don’t miss this excellent opportunity to gain strategies to mitigate risks and improve patient safety while virtually networking with other risk management, executive, clinical and patient safety leaders. Registration for each webinar is highlighted below.
United Healthcare has provided these monthly informational handouts:
Thank you for your continued efforts toward helping our members and communities stay healthy. We’re supporting you, your staff and members as they get ready to visit their primary and specialty health care providers for preventive care and for chronic conditions – care that may have been delayed.
All of us at Humana are inspired by your commitment and sacrifice in caring for your patients in the communities we serve together. We deeply appreciate all you have done to stay connected with your patients, and the creative approaches you have developed to care for our members during this crisis. Some members have used telehealth as a means to stay connected with their care providers while others may have delayed care while at home, which could adversely impact their health.
We know how important it is to have the Priority Health members you see assigned to your practice. That’s why we’re making changes based on your feedback to improve our member assignment.
We’ve started with our individual product reviewing our members’ assignment against claims data. Effective May 1, we’ve updated HMO and POS members’ assignments when they’re seeing a PCP different than the one chosen at enrollment. Members seeing a provider at the same office or accountable care organization (ACN) assignments will not change.
United Healthcare has provided some recent updated information.
May 2020 UnitedHealthcare Network Bulletin Summary. The entire Network Bulletin may be found at: www.UHCprovider.com > Resource Library > Network Bulletin.
Also included are updates related to COVID related policies for UHC.
Please read attachments for fourther details.
Aetna Better Health has provided updates to their COVID policy for their face to face requirement as of May 1st:
Also, ABH recently sent telehealth surveys to practices - see attachments:
We’re in this together. Our commitment is to work with you and keep you updated with the information you need to care for our communities.
Please review the attached provider notifications sent via fax blast recently by Aetna Better Health:
In addition, please review the attached MSA COVID 19 Bulletins.
Attached you will find the monthly handouts from Meridian for the month of April 2020:
Topics include:
Please read the attached latest issue of the Priority Health Physician and Practice News Spring 2020 Digest.
Included in this issue is the latest information on:
Please join United Healthcare Veterans Affairs Community Care Network ( VA CCN) for virtual one hour educational presentations to learn more about VA CCN, treating Veterans, and doing business with VA and Optum.
Registration is required and space is limited. Please see attachment for scheduled dates and times for the upcoming training sessions.
Please review the attached provider notifications from Aetna Better Health:
We’re in this together and are committed to working with you. As promised, we’ll stay in touch with information you need to care for our communities.
Meridian has provided an update to processes based upon the COVID-19 pandemic. Please see the attachment for details.
While you and your organizations are dealing with the challenges of the COVID-19 pandemic, your Affirmant team is here to support you.
Medicaid Communications:
Costs should not be a barrier to patients’ treatment for COVID. Building on previous actions to waive member cost share for COVID-related testing, we have expanded these waivers to now cover all COVID-related medical treatment. Please reference Humana’s COVID-19 Provider Website for details.
From Meridian:
Please see our operational changes (attached) to provide administrative relief to our provider partners. We hope this helps in easing administrative tasks during this time.
Hello Provider Partners-
Sharing some important Aetna Telemedicine Policy revisions that were made 3/31, this update includes the most recent CMS revisions. Please review the policy for a complete list of specific services as 77 codes were added to temporary coverage. *Note that the added services require synchronous audiovisual communication. I have also attached the covered CPT codes from policy in excel format incase makes easier to load these to your systems.
The attached updated policy includes temporary coverage of services in the following areas:
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.
