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Network Relations
Payer Updates Sent on behalf of Brenda R. Lever, Director, Provider Network Management, Blue Cross Complete of Michigan Effective September 1, 2020, Blue Cross Complete will implement two policy updates. The updates are as follows: Modifier 25 policy update – Blue Cross Complete will pay a reduced reimbursement of certain evaluation and management procedures billed...
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Payer Updates 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? The GuidingCare tool is for procedure, inpatient, behavioral health, home care and skilled...
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We’re improving our peer-to-peer process with a single phone line to help you work with us quickly and easily. Effective July 1, you will have one phone number to call if you want to schedule a peer-to-peer conversation with a medical director for inpatient and outpatient services. The phone number is 616.464.8432. Additionally, we’ve expanded...
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Background information 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. This spring, we’ll review our HMO and POS members’ assigned Primary Care Provider (PCP) compared to the PCP they’re seeing based...
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In July and January of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs. So far in 2020, we’ve added 45 new drugs to the formulary. We’ve also made positive changes (reduced tier or removal of authorization...
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Contact: Eve Pidgeon 734-343-1270 pidgeone@trinity-health.org Livonia, Michigan — January 13, 2020 — Trinity Health ACO, a Next Generation Accountable Care Organization (ACO), achieved a nearly 98 percent quality performance score and $22.4 million in shared savings in performance year 2018. The Next Generation ACO Model was created by the Centers for Medicare & Medicaid Services...
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Administrative details – (pg. 11) Measure rounding – PIP measures round up if the score is within 0.5% of the target. Example: If the score is 89.4, it will round to 89. Alternatively, if the score is 89.5, it will round to 90. PPACA – (pg. 12) The Patient Protection and Affordable Care Act (PPACA),...
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Please find attached the current Prior Authorization Matrix for Molina to be utilized for Affinia Health Network. The Prior Authorization Matrix only applies to AHN members if you participate in Affinia’s Molina contract. If offices participate with Molina through a direct arrangement, this authorization matrix will not apply to you. If you have questions, please reach...
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Molina Healthcare of Michigan (Molina) has contracted with eviCore healthcare (eviCore), an independent specialty medical benefits management company, to provide outpatient utilization management services. The new program is designed to streamline the authorization process through on-line and/or phone requests. eviCore will manage prior authorization requests for the following specialized clinical services, effective for dates of...
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Dear Providers, Based on your feedback, Meridian is making improvements to help make your job easier. We understand communication is key, so we’re implementing a monthly notification process to share updates around quality, operations and more. Additional information will be posted individually to the Bulletins page on our website. We will continue to communicate regularly....
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