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Priority Health is actively informing our physician practices about various incentives that they offer physicians, especially primary care. You can choose to participate in these, or not. It's up to you.  There is some money there to be had, however, Priority Health doesn't have very many members yet in Southwest Michigan, so the volume of patients that you could potentially receive incentive monies on, is low.

The surveys are optional as well. You can choose to complete them or ignore them, it's up to you. 
 

Reimbursement Advocate Alert for November 15, 2012 from the Michigan State Medical Society

Lakeland Hospital has a long standing contract with CIGNA.  This is a hospital-only contract and does NOT include all of the Lakeland Care physicians underneath it. This contract was renegotiated in the spring of 2012 to be effective until December 31, 2012.  This deadline has recently been extended until March 31, 2013 in order to give the Lakeland Care PHO time to work with CIGNA on a PHO contract.  A PHO contract with CIGNA would be inclusive of both the Lakeland Hospitals as well as the Lakeland Care physicians.

Announcing Lakeland Care COMET — Continuing Online Medical Education and Training. Your online source for obtaining CME credit and tracking your CME credits.

Physicians have access to videos from the 2012 Weekly CME Program and lectures from Graduate Medical Education. New videos are added weekly. Physicians have received a personalized email from “admin@lakelandcare.com” with instructions on how to access COMET and set their password.

Our Lakeland Care physicians that currently see Care Source patients will continue to be considered participating under McLaren Health Plan.

Effective 8/1/12, those Care Source patients should be presenting in your office with a new McLaren ID card. You can continue to see these Care Source/McLaren patients as a participating physician.

For claim payments from United Health Care, please be advised that this new contract's fee schedule is based off of the 2010 Medicare base rates, so they may not match the 2011 base rates used for the current Lakeland Care fee schedule.

For claim payments from Priority Health, please be advised that this new contract's fee schedule is based off of the current year Medicare base rate, per the contract language.  This means their fees are based on the 2012 rates.

The longstanding contract that Lakeland Hospital has held with CIGNA has recently been renegotiated.  There will be no disruption in the continuity of care for CIGNA patients.

CIGNA will be sending their participating physicians and members a notification letter to inform them of the renegotiation.

Please be advised that as a participating Lakeland Care provider, you DO participate with this insurance, through our agreement with Cofinity.

The ID card will show MiHIP, the Cofinity logo, but no Lakeland Care logo.  You ARE PARTICIPATING and will be paid at the Lakeland Care fee schedule when you care for MiHIP patients.

 The plan is administered by PHP of Lansing.

Please be advised that there was no change to their access to the Lakeland Care network. The ID cards were printed in error without our logo. ASR will be reprinting the ID cards for the Berrien RESA employees that will once again include the Lakeland Care logo.

This year United Health Care Community Plan will be offering grant opportunities in the following categories:

*Women's Care
*Patient Centered Medical Home (PCMH)
*Non-emergent ER reduction

UHC Community Plan encourages you to start thiking of methods to utilize additional funding to improve the delivery of care in these categories for their Medicaid members.

Lakeland Care has executed a contract with United Health Care (UHC) to provide access to all Lakeland Care physicians, and all Lakeland facilities and affiliates. The effective date of this contract is 3/15/12, therefore all Lakeland Care physicians will be participating with UHC starting on 3/15/12 and going forward. 

Lakeland Care has executed a contract with the Pokagon Band of Potawatomi Indians to provide access to our specialists.  The agreement does not meet our minimum contract terms as they are looking to access only our specialists, OB/GYNs, and pediatricians. The Pokagon’s have a primary care health clinic located in Dowagiac that acts much like a Patient Centered Medical Home that will coordinate referrals and authorize treatment by our specialists. 

Lakeland Care issued a new fee schedule that went into effect for all Lakeland Care payors on 1/1/12.  However, Aetna/Cofinity was unable to meet that deadline so they have been allowed to load the new Lakeland Care fee schedule for dates of service beginning 2/1/12 and going forward.

If you are seeing January claims being paid at the old fee schedule rates, that is correct and has been approved by Lakeland Care.  For February dates of service, however, those claims should be paid according to the new Lakeland Care fee schedule.

Their mailing address, phone & fax numbers will stay the same but their website will change to www.mhplan.com.

The Claims Dept moved next door on Woodward Avenue, so the claims address may change for billers submitting paper claims. They will send out notices when that takes effect. Their payer ID did not change so the process is the same for electronic billers.

All Great Lakes Health Plan patients will be reissued new ID cards.  The top of the new card will read "UNITED HEALTH CARE" and in the lower right hand corner of the card you will MEDICAID written in small font.

The change is part of a national branding campaign that United Health Care medicaid groups are undergoing to simplify their name from state to state. 

What will change? Their logo, the ID card, and their website.  Please update your Great Lakes Health Plan website address to be www.uhccommunityplan.com.