News

Information to sign up for Centine (Meridian Health) Monthly Provider Updates can be found by registering at:  mhplan.com  

Currently, there also are Complete and Ambetter independent websites that providers could register for access to those websites and look for any current updates,

To access Ambetter website:   ambettermeridian.com 

From Humana --

An important message regarding  Humana’s COVID-19 response:  ADMINISTRATIVE UPDATE   Jan. 20, 2021

Like you, we are concerned with the unprecedented surge of COVID-19 cases in Arkansas, Colorado, Delaware, Idaho,

Indiana, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma,

Pennsylvania, Texas, Utah, Virginia and West Virginia. We strive to understand the unique challenges different states face

and determine how we can help.

Stay informed about COVID-19

Latest COVID-19 news from UnitedHealthcare – Updates to temporary COVID-19 treatment and prior authorization provisions, reminders on vaccine administration reimbursement

Thank you for all the work you continue to do to care for your patients during this time. We are sharing the following updates to help you deliver care and be reimbursed for the services you provide:

Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.

Humana is providing these documents as a resource for practices:

• Humana Claim payment Inquiry Resolution Guide
• Humana Tools and Resources for Physicians and Healthcare providers
• Availity Overpayment Tool: How to Access the Recorded Training Session

Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.

What you need to know

Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.

Examples of fraudulent requests:

UnitedHealthcare is extending the temporary suspension of select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide through Jan. 31, 2021. The temporary suspensions are effective from Dec. 18, 2020 through Jan. 31, 2021. (They were previously set to end on Jan. 8, 2021.)

Please read the attachment for the latest news from Priority Health!

In addition from Priority Health:

The 2021 PCP Incentive Program (PIP) manual is finalized and available for download. Visit 2021 PCP Incentive Program Manual (priorityhealth.com) to view.

Overview of 2021 finalized PIP manual

2021 new measures

Since the COVID-19 pandemic began, CIGNA has delivered timely accommodations to providers and customers, and ensured that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.

Please read the attachment for details on vaccines, treatments and extended coverage accommodations.

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

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