2010 August/September - Physician and Practice Information
We have decided to cancel the 2010 Priority Health Academy in Grand Rapids, Farmington Hills and Traverse City.
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Criteria for meeting this measure specify not only that children must be up to date on their immunizations, but that they become current on or before their second birthday. Immunizations given after the second birthday will not meet PIP requirements. Consider reviewing your Childhood Immunization listing now, noting the child’s birthday, and scheduling visits for needed immunizations, especially for those children yet to turn 2 in 2010.
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Instructor Judy Breuker will be teaching upcoming coding classes. Information on these classes and others is available in the "schedule" section of the Provider Center.
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Michigan Antibiotic Resistance Reduction Coalition (MARR) and Wayne State University School of Medicine have developed a new, CME-accredited program designed to promote appropriate management of upper respiratory infections.
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Follow these instructions when correcting previously billed claims.
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When monitoring HbA1c and LDL levels, please remember that we measure the last test done in 2010.
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In October 2009, when a limited amount of H1N1 vaccine became available, the public was divided over whether to get vaccinated. Some people seemed to think there was a trade-off between accepting the perceived risk associated with the illness and accepting any perceived risk associated with the vaccine.
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On May 18, 2010, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria.
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Last year, QVAR, Pulmicort and Symbicort were moved to a tier 1 (generic) copay for commercial members. We recently informed members taking asthma long-term controllers of lower-cost alternatives.
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Improve your adult generic PIP incentive score by using the following table to choose generics in commonly prescribed therapeutic classes.
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Complete Partners in Performance (PIP) details are available online. On our Performance Programs page you will find a link to “2010 PIP program.” Please note that you need to be logged in to view PIP information. You may contact your provider account representative (PAR) directly if you have questions.
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View the latest medical policies.
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Medicare crossover is a national process which passes eligibility information between insurers and Medicare’s Coordination of Benefits Contractor (COBC).
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Priority Health will reimburse practices achieving PPC-PCMH NCQA recognition.
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These provider tools are available 24-hours a day, seven days a week online.
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If you don’t currently have an EMR/EHR or other tracking system, you can review your patient’s PIP needs in Patient Profile. Select "Health Condition Search," which will provide you a list of those patients needing services for a specific condition. When you have a Priority Health member on your schedule, go to "Patient Search" and review that person’s status. If there are unmet PIP requirements, print the page and attach it to the chart as a reminder for the provider during the visit.
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Pharmacy benefits among Priority Health members can vary based on the coverage purchased.
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Priority Health Medicare pays for yearly comprehensive physical exams even though Medicare does not, so please continue to encourage your patients to schedule a physical exam. Be sure to include verification of current and past health conditions in their medical records.
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As we told you in the June/July newsletter, the Complexity of Care (COC) Incentive program continues in 2010.
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We’ve set new benchmarks for three PIP measures.
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Before ordering a test or screening listed in the Preventive Health Care Guidelines, you and your patient should understand whether it will be covered as preventive care or as diagnostic care. View more information on preventive health guidelines.
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Effective July 1, 2010, prior authorization is not required for behavioral health office visits for initial evaluations or emergent evaluations.
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The Priority Health Quality Awards were established in 2003 to recognize excellence in health care. Quality Awards are presented in two categories: Exceptional Patient Care and Outstanding Health Care Value.
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We require BMIs to be calculated and recorded during the patient’s visit to your office at least once per calendar year. The purpose of this is to make you aware of the patient’s BMI and remind you to talk with the patient immediately if needed. You’ll find educational tools to help with that conversation here.
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Please contact your PAR if you need more “Make Your Move” reminder cards. You can send these free cards (which come with envelopes) to your patients who need services.
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Priority Health has released a suite of personalized smartphone apps for member ID cards, a first for the industry. The apps, for iPhone, BlackBerry and Android, will provide members with a mobile ID card. Click here for more information.
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The Spine Centers of Excellence (COE) Medical Policy was updated with the addition of ICD-9 code 847.0 (neck strain) with effective dates of service August 1 and after.
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Health care choices aren’t always simple – that’s why Priority Health is offering a surgical decision making tool for our members. This online tool can guide members through the surgery process by helping them find the right doctor, learn about hospitals and how to recover at home.
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We’ll be upgrading our system from September 3 to 6, causing a slight delay in mailed and EFT checks. Checks normally processed on Sunday won’t be processed until Tuesday, September 7. We don’t foresee any technical issues but will post in the Provider Center if extended delays do occur.
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To protect children from vaccine-preventable disease, consider participating in the VFC Program.
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If you have questions about information in this edition of Physician and Practice Information, call your provider account representative, your provider account coordinator or the Provider Helpline at 800 942-4765.
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