HealthbyChoice FAQs
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Submitting the information
Q: Are there other ways to report the required information instead of the qualification form? No. Even if all the health criteria are in the patient's Patient Profile, you still need to complete and submit a qualification form. Log in to your Provider Center and click HealthbyChoice, then search for the patient. Complete the data and dates the data was collected, then click the Submit button.
Q: Do I have to complete the qualification form if the required information is already in the Patient Profile tool as part of the PIP requirements? Yes.
Q: What happens if I submit an incomplete form? On the online form, if you click the Submit button on the online form, missing information will be highlighted. Paper qualification forms with missing information will be faxed back to you with a form indicating which information is missing.
Q: Can I fill out a paper form and let the member send it to Priority Health? No. Providers must record and submit the information.
Q: Can the information be entered online by my office staff? Yes. Logging in counts as the "provider signature." You can authorize your staff to enter the required information using the online qualification form and to submit it.
Q: Can a nurse practitioner or physician's assistant submit the qualification form? Yes.
Health indicator criteria and testing
Q: The criteria don't represent optimal health. Why were they selected? The health indicators were selected because they represent controllable health behaviors commonly associated with chronic illnesses and other health issues. Members who meet the criteria, or who meet the alternatives provided, are taking the right steps toward healthier lifestyles. They're also required to complete an online health risk appraisal.
Q: Am I required to define or outline any treatment program in which I ask the patient to participate? - For HbC Incentives, you must define a follow-up treatment plan when the patient fails to meet one of the three criteria.
- For HbC Achievements, you aren't required to define alternative goals or a treatment plan when your patient has no medical reason to fail meeting the criteria. However, you may suggest ways to live healthier and encourage the patient to try again to meet the criteria whenever they're ready. You may also suggest they contact Priority Health Customer Service for health coaching.
- For HbC Progressions, Priority Health has defined alternate goals for patients who are medically able to meet the criteria but don't.
See the plan designs chart for more details.
HIPAA
Q: Should I be concerned about any HIPAA violations on the qualification form that I provide to Priority Health? No. Submitting the form to Priority Health falls under the category of normal health care operations.
Q: What does Priority Health do with the information on health criteria and any lab results? The information determines a member's benefit level. Priority Health also uses it for wellness resources and services programming. All information reported on the qualification form is stored in the member's Patient Profile. This record is available only to members and their providers.
Provider payment
Q: Are providers compensated for completing the qualification form? Yes. Priority Health pays $30 per member for each form completed and submitted online. If a member doesn't qualify for Choice level the first time you submit the form, we will pay you $10 for each time you submit an updated form for the member.
Q: If the information is already in Patient Profile, will I still get paid for submitting the qualification form? Yes.
Q: Will I be compensated for completing and submitting the qualification form even if I didn't see the plan member? Yes, as long as the tobacco use, BMI and BP measurements were recorded during an office visit within 6 months of the date you submit the qualification form.
Q: What if one of my patients is currently covered by another insurer but is switching to a HealthbyChoice plan? You may submit the form at any time before or after the patient's HealthbyChoice plan effective date. Tobacco, BMI and blood pressure measurements will be valid if dated up to 6 months prior to submitting the form. When your patient visits you for the purpose of completing the form, their current health plan on the date of the visit should reimburse you for the visit.
Q: How is compensation handled in cases in where multiple providers enter information or complete and submit the qualification form? In most cases only a single provider will receive payment.
ID cards and benefits
Q: What will the ID card look like? ID cards will show the member's medical plan (PriorityHMO, PriorityPPO, etc.) and the name of the member's HealthbyChoice plan. It will not show the member's deductible or level of benefits.
Q: Will patients receive new cards if their benefit level changes? No. Use Member Inquiry in the Provider Center to find out if members have Standard or Choice benefits.
Q: Can a plan member and a spouse or covered domestic partner have different benefit levels? No, not if they're both covered under the same plan.
