2010 April/May - Physician and Practice Information
PIP checks will be mailed by April 15, 2010.
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2010 PIP report and search options are now available in Patient Profile.
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All primary care practices with 100 or more members are included in the 2010 Recorded BMI measure.
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For both the Diabetes Care: Controlled Blood Pressure and Hypertension: Controlled Blood Pressure measures, members are included if they have a billed diagnosis of hypertension between January 1 and June 30, 2010.
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A new measure for 2010, Optimal Diabetes Care offers an additional incentive for exceptional care of diabetic members.
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2010 is the second year in which non-adherent exclusion requests are accepted for review. For 2010, a few updates have been applied to this program.
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PIP reports are generated each month. There are a large variety of report options available to assist your practice with tracking performance.
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We want to ensure practices receive the credit they deserve for all PIP 2009 measures. As a result, two adjustments have been made in measuring for PIP 2009.
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Annually, Priority Health participates in the Healthcare Effectiveness Data and Information Set (HEDIS) methodology of collecting, measuring and reporting performance indicators. By doing so, Priority Health has the opportunity to measure the quality of care our members receive.
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Authorization requests aren't required for members using their alternate benefits or out-of-network benefits.
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Priority Health's mission is to be the nation's leader in innovative health solutions – making health care obtainable for all. We're committed to providing affordable and excellent health care to individuals and employers through an ever–expanding array of products and services.
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We recently made changes to our Provider Helpline phone queue. Please listen to our new and improved options to ensure you're connected with the appropriate Priority Health representative.
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We now offer three individual plans.
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Medicaid members have access to the American Cancer Society quit-line services for the state of Michigan, which have transitioned to Free & Clear, an organization specializing in phone-based, cognitive behavioral health coaching and web-based learning.
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Medication errors continue to kill more than 7,000 Americans each year. Approximately 82% of adults and more than half of the children in the United States take at least one medicine daily, yet many people don't remember the names of their drugs, what they are for or how often they are taken.
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Tackling inactivity and reducing the number of overweight children and teens are key to turning heart health statistics around in 2010. Data from 2003 to 2006 shows 11.3% of children and teens were at or above the 97th percentile in BMI for their age – an ominous sign because overweight teens have a 70% chance of becoming overweight adults.
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Preconception planning is being intentional about preparing for and starting pregnancies. It includes making decisions about when to have children, how many to have, how to time pregnancies, and how to ensure the healthiest pregnancies and families.
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Often, physicians complete the services of a Medicaid well-child visit (physical, developmental screening, anticipatory guidance, BMI percentile, and counseling for nutrition and physical activity) but aren't receiving credit because visits may not be billed correctly or are missed.
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Empower your patients: The PATH (Personal Action Towards Health) program, also known as the Stanford Chronic Disease Self-Management Program, is a powerful workshop designed for people with ongoing health conditions like heart or lung disease, diabetes, and arthritis.
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If you have questions about information in this edition of Physician and Practice Information, call your provider account representative, provider account coordinator or the Provider Helpline at 616 942-4765 or 800 942-4765.
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Nine network practices have received the National Committee for Quality Assurance (NCQA) Physician Practice Connections (PPC) Patient-Centered Medical Home (PCMH) recognition.
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Priority Health supports the PCMH model for changing reimbursement.
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Generic Ultram ER (tramadol ER), Mirapex, and Pulmicort Respules are available!
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Priority Health has timelines in place for responding to urgent prior authorization requests. These timelines ensure all members receive appropriate, timely pharmaceutical care based on sound evidence and individual needs.
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Priority Health updates the formulary up to six times a year (negative changes occur only twice per year) and reviews Pharmaceutical Management Procedures annually.
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On Jan. 1, 2010, Symbicort became available to members at a generic copay (tier 1). Symbicort joins QVAR and Pulmicort as the third asthma long-term controller available at a generic copay.
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Jan. 19, 2010 P&T changes: At a glance
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Studies show a significant lag exists between earliest concerns and actual reported identification of Autism Spectrum Disorders (ASD), thus contributing to potentially significant delays in intervention. Because of the benefit of early intervention, identification of developmental disabilities by health care professionals at earlier ages is essential.
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Find ongoing seasonal and H1N1 vaccine updates, journal articles, international news, flu resources, and pandemic preparedness issues and information.
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We are now covering Prevnar-13 as indicated for active immunization of children 6 weeks through 5 years of age for the prevention of invasive disease. Prevnar-13 is recommended to be administered as a 4-dose series at 2, 4, 6, and 12 to 15 months of age.
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The "Shots 2010" quick reference guides to the adult, teen and child immunization schedules and the immunization catch-up schedules are now available for Palm-OS handhelds and Pocket-PC handhelds.
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Free CME at medscape.com.
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