News

As the public health emergency continues, and the country slowly starts to reopen, we continue to look for ways to support our customers and the providers who are dedicating their lives to deliver important care.

myHealth Wellness Program Postponed   

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.

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.

As we shared earlier, on September 14, we’re launching GuidingCare, a new authorization tool that will replace Clear Coverage. Make sure you’re ready to successfully request authorizations this fall by registering for webinar trainings. 

What steps do you need to take to ensure success?

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:

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.

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

In response to the COVID-19 pandemic, we implemented several temporary changes to support you and your patients.

The purpose of this communication is to give you an update on which of these changes is ending on June 30, 2020, and what’s being extended. We’ve also made a new change for July 1, 2020.

Attached you will find the monthly handouts from Meridian for the month of June 2020:

Topics include:

• A Welcome from Meridian Health and  Services Provided by Community Health Workers Available to Members
• Childhood and Adolescent Immunizations
• Well Child Exams and Lead Screening
• Adult BMI Assessment and Nutrition Counseling for Childrena and Adolescents

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

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.

UnitedHealthcare June Network Bulletin

Front & Center
• COVID-19 Antibody Test Registration Requested (page 5)

1.            All hospital-affiliated and freestanding laboratories, as well as physician practices with in-house laboratories, are being requested to register the COVID-19 antibody test(s) that will be used for our members.

Attached are two handouts supplied from Meridian for May 2020:

• Children's Behavioral Health Measures
• Adult Behavioral Health Measures

Have you been enjoying these monthly updates? Would you prefer to receive them via email? Visit the Bulletins page for your state and fill out our sign-up form to receive the monthly update directly in your inbox!

Priority Health has NEW Claims tool which now supports Microsoft Word and Excel file attachments for appeal and medical record submissions

The Claims tool within the Provider Portal now supports Microsoft Word (.doc and .docx) and Excel (.xls and .xlsx) file attachments for appeal and medical record submissions. This is in addition to file types already supported, which include: csv, .pdf, .png., jpg, .jpeg and .txt.

Beginning the week of May 18, 2020, we’ll be reaching out to Medicaid members, or guardians, who are due for immunizations, asking them to schedule these appointments with their primary care providers (PCPs).

We’re also resuming sending reminders for well-child visits. These reminders are sent quarterly via letter or email and ask members, or guardians, to schedule the appointment with their PCP.

Immunization campaign

We’ll be reaching out to two groups of members with phone calls from our customer service team:

In honor of Risk Management Week, Michigan Professional Insurance Exchange is extending this special invitation to you to join us for three separate webinars, June 16-18 for the 2020 Regional Education and Networking Meeting. Don’t miss this excellent opportunity to gain strategies to mitigate risks and improve patient safety while virtually networking with other risk management, executive, clinical and patient safety leaders. Registration for each webinar is highlighted below.

UnitedHealthcare Is Waiving Cost Share for Medicare Advantage Members

Thank you for your continued efforts toward helping our members and communities stay healthy. We’re supporting you, your staff and members as they get ready to visit their primary and specialty health care providers for preventive care and for chronic conditions – care that may have been delayed.

We know how important it is to have the Priority Health members you see assigned to your practice. That’s why we’re making changes based on your feedback to improve our member assignment.

We’ve started with our individual product reviewing our members’ assignment against claims data. Effective May 1, we’ve updated HMO and POS members’ assignments when they’re seeing a PCP different than the one chosen at enrollment. Members seeing a provider at the same office or accountable care organization (ACN) assignments will not change.