News

Peer-to-Peer Reviews – Improved Scheduling

In an effort to respond to network provider feedback with respect to the scheduling process of peer-to-peer reviews, there is a new effort underway at UHC to improve the provider experience with our Peer-to-Peer review process.

Meridian has provided some informational handouts on the following topics:

• Influenza Vaccination
• BMI Measurement and Counseling for Nutrition and Physical Activity
• Prenatal Care/ Scheduling Postpartum Care
• Chlamydia screening

Meridian has provided some informational handouts on the following topics:

• Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
• Dental Care Information
• Appropriate Treatment for Children with Upper Respirator Infection/ with Pharyngitis
• Well Child Exams and Lead Screening
• Potentially Harmful drug-Disease  Interactions in the Elderly
• Childhood and Adolescent Immunizations
• Colorectal Cancer Screening
• Medication Reconciliation Post Discharge

Katie Rogers, our SW Michigan Provider Relcations Consultant for Blue Cross, has informed us that beginning 10/1/18, Blue Care Network (BCN) will utilize AIM for cardiology and high-tech radiology prior authorizations. If your office or department requests prior authorizations, please take advantage of several webinars that BCN has created for you.

Priority Health is making changes to their eviCore prior authorization program based upon your feedback to better serve you while ensuring our members are getting high quality, cost effective care.

Starting on Sept. 5, a subset of the high-tech radiology CPT codes will stop auto approving and will require authorization.

This means:

Some requests may pend for additional information. Once the information is received a decision will be made within two (2) business days.

In October 2018, Humana will be permanently closing their secure portal on Humana.com and migrating to Availity.com. 

Attached you will find an Availity Webinar Schedule if anyone in your office needs assistance, as well as an informative PDF about the upcoming switch.

New Medicare Card: MBI Look-up Tool Available through your MAC

Preparing for an Aging Workforce

Are you prepared for an aging workforce? Does your organization have resources available to employees with aging or ill family members? Many people do not know where to turn for help when faced with challenges related to aging, retirement, illness, palliative care or end-of-life related situations. Learning about the aging workforce is an opportunity to better prepare your organization and your employees for this change of life.

Meridian has provided information sheets on the following topics:

• Comprehensive Diabetes Care
• Controling High Blood Pressure
• Healthy Michigan Plan - Health Risk  Management
• Medication Management for People with Asthma
• Tips for Improving Medicatieon Adherence
• Well Care Exams
• Lead Screening
• Meridian - What We Do

Attached is information from United Healthcare regarding their new Dual Complete (HMO-SNP) program. Attached are two resources for your reference. There is a powerpoint which explains the program in detail, as well as a Quick Reference Guide for a handy reference.

The Lakeland Medical Office Association (LMOA) invites you to attend their April luncheon and meeting.

PROGRAM:  Risk Mitigation Best Practices in the Physician Office

Lakleand Care has learned that Priority Health has only loaded some of the midlevels that we have credentialed since September of 2016, which is causing billing issues for our practices and hopsitals. Therefore, for Priority Health patients only, please continue to bill services provided by your midlevel practitioners, under their supervising Lakeland Care physician until further notice.

The Lakeland Medical Office Association (LMOA) invites you to attend our March luncheon and meeting.

PROGRAM:  The Reality of Human Trafficking in Michigan

Sex trafficking does not happen only in big cities. It is an evil that lurks throughout this country and around the world. It’s time to expose the darkness.  Come hear a personal story of survival, from Melinda, a human trafficking survivor.

UnitedHealthcare Dual Complete (HMO-SNP) is now offered by UnitedHealthcare Community Plan of Michigan

Effective Jan. 1, 2018, UnitedHealthcare Community Plan of Michigan will begin to serve eligible members in a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete Medicare Advantage ‒ in the following counties: Berrien, Branch, Gratiot, Hillsdale, Tuscola and Washtenaw.

North America Administrators (NAA) was one of Lakeland Care's Employer-Specific payors. Lakleand Care providers participated with NAA only for the K&M Machine covered employees.  Lakeland Care just received notice that K&M Machine terminated with NAA effective 8/31/17. We are not aware of what payor they might have moved to.  Therefore, please ask K&M patients for an updated insurance card.

UHC has recently made two additions to their UHC-Community Plan website. DSNP  Prior Authorization Lists and Frequently Used Forms information regarding the Dual Complete Plan should be easier to find now. 

The following links will  provide you easier access in finding information on the UHC-CP site:

CHAMPS Enrollment Enforcement

CHAMPS is Michigan Medicaid’s Provider Enrollment System

• January 1, 2018, all providers furnishing services to Medicaid beneficiaries must enroll in Michigan Medicaid per federal requirements.

                        – Includes providers participating in a managed care organization’s provider network.

MPIE invites you to participate in the following webinars…

The Devil is in The Details: How Documentation Can Make or Break You

February 15, 2018 | 12-1 p.m.

On January 1, 2018, Lakeland Care Network welcomed a new commercial contracted payor - SecureOne. 

SecureOne contact information is as follows: