News

MDHHS: Grant Information on PPE for Medical Facilities and Providers

August 31, 2020
Providers

MDHHS Announces $25 million for Personal Protective Equipment to Keep Frontline Workers and Patients Safe from COVID-19  

 

LANSING, MICH.  A $25 million grant program for personal protective equipment (PPE) will allow medical facilities and other providers to keep their staff and patients safe, the Michigan Department of Health and Human Services (MDHHS) announced. 

   

ABH - New Lockbox Address and Update Letter for EM Codes

August 27, 2020
Providers

Aetna Better Health has sent a Provider Bulletin informing us of a NEW lockbox changes as of 6/15/2020; please see the attachment below

They also have sent a letter regarding an  E & M coding letter explaining current practices and policies; please also see that attachment.

 

 

Affirmant Health Partners: COVID-19 August 26, 2020 Weekly Update

August 26, 2020
Providers

The current healthcare landscape is rapidly changing. We understand the extraordinary challenges our Members face daily and how difficult it can be to keep up with the most recent COVID-19 developments. With this weekly newsletter, we will provide you the latest news trending in healthcare.

If you haven't visited our site in a while, we have also added a few new focus areas:

Priority Health - Updates to 2020 Incentive Programs

August 18, 2020
Providers

We’ve revised our PCP Incentive Program (PIP) and Comprehensive Primary Care (CPC+) Program to reflect updated HEDIS information. Several measures have added additional opportunities for gap closure and/or exclusion criteria. In addition, we’ve made changes to the Healthy Michigan Plan: HRA measure which will be effective with the next Filemart report release. HEDIS measure changes are effective July 1, 2020.

 

Affirmant Resource Hub- Weekly Top Three - August 12, 2020

August 12, 2020
Providers

The current healthcare landscape is rapidly changing. We understand the extraordinary challenges our Members face daily and how difficult it can be to keep up with the most recent COVID-19 developments. With this weekly newsletter, we will provide you the latest news trending in healthcare.

If you haven't visited our site in a while, we have also added a few new focus areas:

HHS Extends Application Deadline for Medicaid Providers and Plans to Reopen Portal to Certain Medicare Providers

August 5, 2020
Providers

A Note from Meridian Health:

The Medicaid Targeted Distribution Funding through the CARES Act application deadline was extended for 1.) Phase 2 general distribution to Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP) and dental providers, and 2.) certain Medicare providers who experienced challenges in the Phase 1 Medicare General Distribution application period. These groups can apply for relief funding through Friday, August 28, 2020 according to the HHS press release issued on July 31.

 

From the press release:

Veterans Affairs Community Care Network Training Sessions from UHC-OPTUM

August 4, 2020
Providers

Physicians, Practice Managers, and Staff,

Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You’re invited to a Veterans Affairs Community Care Network Overview educational session.

Join us for one of the following virtual one hour educational presentations to learn more about VA CCN, treating Veterans and doing business with VA and Optum.

During this webinar we will discuss:

• VA CCN Overview

• Referrals and Appointment Scheduling

• Providing and Coordinating Care

United Healthcare Extends National Public Health Emergency Temporary Program Changes

July 27, 2020
Providers

UnitedHealthcare recognizes that the persistence of COVID-19 cases across the country continues to have an impact on the healthcare system – both for COVID-19-related care as well as for regular preventive visits. To provide ongoing support to members and providers, UnitedHealthcare is extending many of the COVID-19 temporary program, process and coverage changes through Oct. 22, 2020.

UHC: HHS Provider Relief Fund Extension

July 23, 2020
Providers

From United Health Care:

Please see the attached Collateral that will inform you on how to apply for additional Relief Funds:

  • How to apply:
  • Eligibility Requirements
  • Use of Funds
  • Attestation Requirements
  • Where to find more information site.

Please note even thought this form stated expires 07/20/20, again the state has extended applications till August 3rd 2020.

Again, please see the attachment for details.

Meridian Health - HEDIS STOPS: Pediatric Provider Information

July 22, 2020
Providers

Meridian Health has sent a provider educational handout which explains MDHHS guidelines for getting children caught up on their vaccinations. It has some  great tips for your providers at their practices and also has safety protocols. Please pay attention to page 4&5 for the immunization specific guidance.

Plese see the attachment for details.

Priority Health- DRUG RECALL Metformin ER Products from certain manufacturers

July 20, 2020
Providers

The U.S. Food and Drug Administration (FDA) recently requested that prescription metformin ER products manufactured by Apotex Inc., Amneal Pharmaceutics, Granules Pharmaceuticals and Lupin Pharmaceuticals be removed from the market. This is due to a minor impurity. Recalled strengths vary by manufacturer.

 

Metformin products treat conditions like type II diabetes.

 

We’re notifying members

UHC and Optum VA Contract Updates

July 14, 2020
Providers

Department of Veterans Affairs (VA) has selected Optum as a third-party administrator for Regions Two of the VA Community Care Network (CCN). This contract became effective on January 20, 2020.

Optum would like to host virtual training sessions before the end of August 2020.

In the meantime, the instructions on the VACCN Referral Process is as follows:

Meridian Health - July 2020 Monthly Handouts

July 13, 2020
Providers

Attached are the Meridian Provider educational handouts for the month of July.

 

  • · Access to Care can be completed via telehealth. Added Table to include telehealth modifiers and POS
  • · For AAP, visit can be completed by any provider specialty
  • · For CAP, visit much be complete with a PCP provider type
  • · Updated periodicity schedule added to page 2 for most current recommendations

 

Dental Care Information

Priority Health Telehealth Update July 1, 2020

July 8, 2020
Providers

Last week Priority Health  announced that on July 1, 2020, we would return to paying the standard facility-based rate for expanded services provided via telehealth.

 

Given the investment our providers have made in telehealth, ongoing concerns about patients not visiting provider offices for needed care, and the rapidly evolving COVID-19 situation, we have reversed this decision. We'll continue to pay at the non-facility rate, using the rest of 2020 to review data on telehealth services to inform our future policies.

 

UHC- July 2020 Network Bulletin

July 1, 2020
Providers

The July 2020 UnitedHealthcare Network Bulletin Summary is attached for your reference. In addition, also attached are informational flyers on:

  • Resource Kit 2020 United Healthcare Community Care
  • Q3 2020 MI Common Formulary Updates
  • Summary of COVID 19  dated July 1, 2020
  • Diabetes Prevention Program

 

 

 

 

Priority Health - NEW Authorization Tool Coming Soon

June 29, 2020
Providers

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.

 

Priority Health - New Medicare Advantage Hospital Admissions Provider and Patient Eduction

June 24, 2020
Plan members
Providers

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.

Priority Health - July 1 Formulary Change for Diabetes Meds Not Occuring

June 16, 2020
Providers

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

Humana - "Test Kits for All" Initiative

June 15, 2020
Providers

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:

Humana - Service Fund offset/reimbursement related to Humana copay, coinsurance and deductible waiver

June 11, 2020
Providers

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.