News

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.

What’s changing

The new upfront rejections included:

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.

Humana has provided the first FAQ related to the COVID vaccine, and it will be updated weekly as new information is available.

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

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. 

• 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

We’re excited to share 2021 product updates for our Commercial and Medicare products. The information below provides an at-a-glance view of changes. For more detailed product information, reference the attachments included with this email or view a recording of our Oct. 15 Virtual Office Advisory webinar, focused on product updates.

To help practices who are busier than normal in 2020 we’ll use our existing data sources to collect Medicaid PCMH incentive information.

As a reminder, the 2020 Medicaid PCMH incentive has 3 requirements:

• Active PCMH recognition
• Participation in the Health Information Exchange through MiHIN
• Engagement with care management

There’s nothing you need to do. We’ll gather this information from the following sources:

CIGNA Network News

Take a peek at one of our top stories

Cigna launches five-year initiative to combat systemic racism

The attached Provider Bulletin No 179 was sent to the Medical Practice Group via fax blast today.  ABH has asked us to inform  practice managers within our network.

Provider Bulletin No 179  November Webinar! Coding Specific Topic: Closing HEDIS gaps for HEDIS 2021

Webinars date/time:

                November 10 – 11:00 AM EST

                November 11 – 2 PM EST

TOPICS:

Below is the UHC November Network Bulletin Summary.  Please review and share with staff as needed.  The entire bulletin can be found at www.UHCprovider.com > Network Bulletin. 

Please read the attachement below fo rspecific details.

From UHC:

Radiology notification regarding CPT codes being added to the Radiology Notification and Prior Authorization list. This will go into effect for claims with dates of service on or after Jan. 1, 2021.

Fellow physicians and healthcare professionals:

The last several months have been unlike any other in our lifetime as we are navigating this pandemic together. However, I believe we will emerge on the other side in a stronger, better state. As we continue along this new normal together, I want to share two updates with you regarding reactivating standard authorization processes and new programs for your Humana patients to support the care they receive from you.

Reinstating Authorizations for COVID-19 Diagnoses

Know your patient's health with the Patient Profile tool.

Providers logged into a provider portal account can see health conditions and lab values and prioritize patient visits based on gaps in care using the Patient Profile tool.

Tools and resources

With the Patient Profile tool you can:

• Display member lab values
• Review preventive exams or test data
• See gaps in care for your patients

Aetna Better Health has sent their September 2020 monthly handouts. Please see the attachments:

• Nursing Facility Infection Prevention and Control Enhancement Grants
• Michigan Medicaid Preferred Drug List - Frequently Asked Questions

IMPORTANT INFORMATION FROM CIGNA

Introducing Evernorth

Stay informed about COVID-19

UnitedHealthcare is updating a number of temporary provisions that were established as part of the COVID-19 response. Here’s a high-level summary of the changes:

Humana on September 2, 2020 will launch a new program.campaign.

Members with  Medicare Advantage who have not had  breast cancer screening or a comprehensive eye exam will be encouraged to schedule their mammogram and/or comprehensive eye exam in consultation with their doctor to keep their health and safety top of mind during the pandemic.

Eligible Members will be receiving an email or leter from Humana duirng the campaign period of September 2, 2020 through November 2020.

You're invited

Virtual Office Advisory
Thursday, September 17, 2020
Noon – 1 p.m. EST

Join us for our upcoming September Virtual Office Advisory webinar and learn about: