News

Dear Physician or Administrator:

As Humana continues to make improvements to the Service Fund system, we want to share these improvements with you.

Bulletin Board System (BBS) Report Archive – BBS data reports older than 12 months will be archived. The archiving will process through the end of 2019 and will be finalized beginning January (PE20200101). The data reports up to 10 years old will remain in the archive. Requests for archived data reports may be sent to servicefund@humana.com.

The PH provider portal has been updated to allow you to ask questions and add an attachment when sending a message in our Claims tool for coordination of benefits, third party liability, claim edits and other claims questions.

They have removed the dropdown option for coordination of benefits, third party liability, claim edits and other related claim questions from Secure Mail. These options are now available in our Claims tool in addition to adding an attachment.

Where to find this new feature in the Claims tool

Effective 1/1/20, Lippert Components is a new employer group who has access to the Lakeland Care Network. This employer group has been added to the LCN Listing of Contracted Payors under the "Employer-Specific Payors" section.  The payor that Lippert has chosen to use is Key Benefit Administrators.  Therefore, all Lakeland Care Network providers are considered participating for all Lippert Components covered members.

Based on the feedback we received at the Payor Conference in October, Lakeland Care Network has planned this special breakfast meeting and invites you to attend so we can bring you information on the new VA Contract with Optum, along with very helpful information directly from Priority Health Claims Department.  This presentation would be helpful for office/practice managers, billing staff, and appeal team members.

LMOA is an independent, non-profit organization dedicated to providing quality education to southwestern Michigan's healthcare community.

The Lakeland Medical Office Association invites you to attend our January luncheon and seminar.  

Program:  De-Escalation Techniques for ‘Bad’ Behavior in Physician Offices

Attention offices!  The preventive lab benefits for Spectrum Health Lakeland (SHL) plan members has changed quite a bit for the new 2020 plan year.

Please refer to the attached Preventive Healthcare Guidelines publication from Priority Health.

Attached you will find the monthly handouts relating to the following topics:

• Tobacco Cessation
• Osteoporosis Management in Women and Preventing Fractures
• Persistence of Beta-Blocker Treatment After a Heart Attack
• Appropriate Screening for Prostate Cancer
• Prescribing Antipsychotic Medications

Please visit the Meridian website for more detailed information.

The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration’s Clearinghouse rules are effective January 6, 2020. The FMCSA Clearinghouse is an electronic database that will contain information about commercial motor vehicle drivers’ drug and alcohol program violations. 49 CFR Part 382, Subpart G

Effective Feb. 1, 2020, all commercial group and individual plans will cover counseling services as a preventive service, for pregnant and postpartum women identified as at-risk for depression.

When preventive, counseling services will be covered at 100% ahead of deductible.

Why are we making this change?

MeridianComplete (Medicare-Medicaid Plan) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective January 1, 2020. This program is designed to work collaboratively with providers in promoting patient safety through the practice of high-quality and cost-effective care for MeridianComplete members undergoing musculoskeletal surgical procedures.

We heard you, and we're making an exciting change to our online provider portal to help you work with us faster and easier. As part of our commitment to reducing your hold time when you call us and giving you more of the information you need at your fingertips, front-end rejected claims and reasons are now available on our provider portal.

Where to find your front-end rejected claims

Priority Health is making changes to their 340B program based on your feedback. PH will now review 340B claims post-payment, which means that they will review paid claims quarterly.

What can facilities expect?

The first post-payment review will begin in December 2019 for providers enrolled in the 340B program. We may contact facilities for a list of drugs purchased through the 340B program or for specific exclusion criteria.  

Does the 340B program apply to Medicaid claims?

Register for a webinar about hyaluronic acid products for knee injections

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