News

Effective Jan. 1, 2020, Medicaid outpatient behavioral health therapy will no longer require prior authorization. You will no longer need to submit clinical documentation for these requests.

Why we’re making this change

We’re removing the authorization requirement to improve members' access to the mental health services they need to ensure they’re able to get the right care at the right time.

 Priority Health offers monthly educational Virtual Office Advisory (VOA) webinars to our providers and their staff. Priority encourages participation in regularly viewing these presentations.

Attached are the informational handouts from Meridian for October:

• Medication Management for People with Asthma (MMA)
• Comprehensive Diabetes Care (CDC) and Controlling High Blood Pressure (CBP)
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
• Preventing Readmission: Following up with Discharged Patients
• Transitions of Care (TRC)
• eviCore Expansion Prior Authorization Overview Training Sessions
• Catching a Breath Program Informationa and Referral Form

Below is Humana's link to Availity. It is optional for providers, but encouraged for easier processes.   Availity is efficient to use rather than traditional calling/faxing when working on the following:

eviCore healthcare and Meridian are expanding their partnership to include the following programs: physical therapy (PT), occupational therapy (OT), genetic testing, pain management, and sleep studies. eviCore will be leading orientation sessions designed to assist you and your staff with the new programs. You will be able to attend the web orientation session that works best for you and your schedule.

Attached are the informational handouts from Meridian for September:

• Low Back Pain and the Use of imaging Studies/ Acute Bronchitis and the Use of Antibiotics
• Pneumococcal Vaccination
• Influenza Vaccination
• American Sign Language Translation Service

US Health & Life is the only remaining LCN contracted payor who is a part of our Cofinity contract  that remains to switch for claims address changes.  Their change date is set for 10/1/19.

Important:  Some Payer EDI #’s were updated since the last version, please look for the Payers with an asterisk next to their name as those EDI#’s will need updated for accurate routing!

Program:        Value-Based Care:  Why, Perspectives, & Future Trends

If you pick up any health care trade publication, you cannot avoid reading a headline regarding efforts to improve “health care value.” However, the what, how and when behind this detailed work varies depending on who you ask; the health plan, the provider, or the patient.

Meridian Health is asking providers to complete their Annual Model of Care (MOC) training for ALL providers who care for their plan members.

You can find this training module at their website: www.mymeridiancare.com for additional instructions; also, please see attachment for full instructions and details on this training from Meridian Health.

Note: One person in the office can take this training, and then train the rest of the office.

Please call Meridian Health for any questions at 1-877-902-6784.

Attached are the informational handouts from Meridian for August:

• August Monthly Provider Update
• Childhood and Adolescent Immunizations
• Care for Older Adults
• DMARD Therapy for Rheumatoid Arthritis
• Statin Therapy and Adherence

Lakeland Care has several payors who are a part of our Cofinity contract.  These payors are listed below:

• Group Marketing
• Liberty Union
• Physicians Health Plan (PHP of Mid Michigan)
• Secure One
• Trustmark - Starmark, Nippon lIfe, CoreSource, NGS CoreSource, FMH
• Claim Choice
• Group Resources
• Healthgram
• Prairie States
• NOTE:  the only payor that at this time has not completed the migration is US Health & Life 

Attached is a brief summary of UHC's electronic data education  which includes information and resources for electronic transactions.

Aetna Better Health  has recently provided the following informaiton:

Please review the information below regarding EVICORE authorizations and appeal guidelines.

Medical Prior Authorizations:   

Note:  If a claim denies not authorized, providers must request an authorization before submitting a provider appeal.  If the retro authorization request is denied, a provider appeal can be submitted to the health plan.

High Tech Radiology Authorizations

Aetna Better Health of Michigan will be updating on or before August 1, 2019 their Provider Manual and Website to provide clearer understanding and instruction to providers related to the various Dispute / Appeal / Grievance processes that are available. These updates apply to BOTH our MI HealthLink Duals product & our Medicaid product. 

Please see attached flyer for more detailed information.

Meridian has provided these informational handouts for refernece:

• Potentially Harmful Drug Disease Interactions in the Elderly
• MeridianRx.com instructions
• Notifications of Enhanced Claim Review Processes regarding clinical chart/DRG reviews
• Use of "Request for Claim Dispute" form for better routing of disputes

Attached is an updated version of the ASR provider manual that has been updated, and will be effective as of July 1, 2019.

Key components of these changes address:

Meridian has provided these educational handouts for this month:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Medication Reconciliation Post Discharge
• Antidepressant Medication Management
• CPTII Codes and HCPCS Billing for Medicare and Medicaid
• Health Michigan Plan -  Health risk Assessment (HRA)
• Meridian RX.com

MeridianComplete (Medicare-Medicaid Plan) will be ending their relationship with ConncertoHealth (Concerto), also known as MeridianCare Continuim on May 31, 2019. A new vendor, H3 Management Services, will begin to provide services as of June 1, 2019. There will be no immediate authorization process changes.

For more details, please see attached document.

As you know, Cofinity is migrating to a new claims repricing platform that requires a change in the traditional Cofinity claim submission workflow. The new platform will streamline their administrative processes and help them improve the service they provide to you and payer clients. 

How this impacts you: