Lakeland Payor Conference 2019 2019 Updates New Updates
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Lakeland Payor Conference 2019
2019 Updates
New Updates • • Health. Help Equian evi. Core Cotiviti Provider Updates CHAMPS PCMH Incentive Program Medicare Transition, January 1, 2020
Health. Help • Provides expert peer consultation and the latest evidence-based medical criteria • Prior authorizations for Oncology and Radiation Therapy 2 D and 3 D • Access website at healthhelp. com or call 888 -285 -0562
Equian • Reviewing facility claims • Itemized bill submission – Secure SSH File Transfer Protocol (SFTP) – Email claimsadmin@equian. com – Mail Medical Claims Coordinator Admin 600 12 th St. , Ste 300 Golden, CO 80401 or Fax 800 -435 -2049
evi. Core • Prior authorizations required for: – Radiology and cardiology services – Outpatient, elective/non-emergent and diagnostic services Authorization is not required for inpatient radiology, procedures performed in the ER, 23 -hour observation, x-rays and obstetrical ultrasounds.
evi. Core • PT, OT, genetic testing, pain management, and sleep studies expansion for Meridian. Health (Medicaid) and Meridian. Choice (Commercial) as of October 1, 2019 • Medicare transition is effective January 1, 2020 • Webinars available in October and November for additional training • Visit evicore. com/healthplan/meridian_wellcare for additional information
Cotiviti • Enhanced retrospective claim review process • Improved accuracy of pre-post payment systems • Data mining and clinical chart/DRG reviews
Provider Updates • New Monthly Provider Newsletters • Visit mhplan. com under “Bulletins” • Request a Claim Dispute Form • Visit mhplan. com under “Documents and Forms”
CHAMPS • Enrollment Requirements for Prescribers • Affects Medicaid, Healthy Michigan Plan, Children's Special Health Care Services (CSHCS) and Maternity Outpatient Medical Services (MOMS) • Medicaid Enrollment Requirements to Providers who prescribe drugs to Medicaid beneficiaries along with claims • Provider enrollment, visit www. michigan. gov/medicaidproviders
PCMH Provider Incentive Program • From October 1, 2019 to December 31, 2019, Meridian will recognize the following: – Accreditation Association for Ambulatory Health Care – Home Medical (AAAHC) – The Joint Commission – PCMH (TJC) – Commission of Accreditation of Rehabilitation Facilities – Health Home (CARF) – Utilization Accreditation Commission (URAC)
Provider Demographic Updates • Methods to verify or update your information – Email at providerupdate@mhplan. com – Fax to 313 -481 -7540 – Call 888— 773 -2647 – Mail • Meridian Corporate Provider Services • 1 Campus Martius, Suite 700 Detroit, MI 48226
Member Eligibility The best way to verify member eligibility is to call Meridian toll-free at: 888 -437 -0606 or Use the Provider Portal login at: www. mhplan. com Medicaid-eligible members only
Medicare Transition On January 1, 2020, Meridian. Care (HMO/SNP) will change its name to Well. Care.
Contact Information Nancy Paskel Provider Network Development Representative nancy. paskel@mhplan. com 313 -820 -2917 Thank you for your partnership in caring for our members.