2010 December - Physician and Practice Information
For most measures, members who are in your practice as of Dec. 31, 2010 and meet eligibility requirements are included in your PIP 2010 measure denominators.
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Remember to run a “Care Opportunities” report in the Health Conditions section of Patient
Profile in December to capture 2- and 13- year-olds who need immunizations in early 2011.
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2011 marks the 13th year of PIP — Priority Health’s physician incentive program.
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A provider may request exclusion of a member at any point prior to Jan. 31, 2011, for the 2010 program year.
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When a patient requests that his or her records be transferred to a new PCP, Priority Health must be made aware of this change.
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We occasionally have questions from providers about labs and services performed at Veteran’s
Affairs (VA) clinics and facilities.
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At times you’ll receive a request from us for documentation included in a patient’s medical chart.
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We’d like to remind you that there were several new ICD-9 codes effective Oct. 1, 2010.
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Effective April 1, 2011, Priority Health is implementing the Michigan Quality Improvement Consortium (MQIC) guideline for office-based surgery requiring moderate or higher levels of sedation.
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We continue to automatically send medical payments and HRA reimbursements to providers. Our new enhancements eliminate the one-week lag between the processing of the medical plan portion and the HRA portion.
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Effective Jan. 1, 2011, we’ll be implementing a new process related to submission of the Provider Appeal Form (formerly provider dispute resolution) for coding and clinical edit related issues.
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We previously told you that HealthGrades ratings would display for all providers when users were logged in. However, HealthGrades ratings will not display for all providers.
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The Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) has awarded a $1.2 million grant to Michigan State University (MSU) to evaluate the effectiveness of patient-centered medical home (PCMH) pilot projects at Priority Health and Independent Health, a New York plan.
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More than 70 primary care practice physicians, nurses, case managers and administrators attended the Oct. 28 Patient-Centered Medical Home Learning Collaborative hosted by Priority Health at the Prince Conference Center in Grand Rapids.
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Priority Health is proud to announce the expansion of its provider relationship with Genesys Health System, a Flint-based delivery system serving patients across six counties.
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We’ve updated our quick reference guide that summarizes the coverage of drugs used to treat common conditions.
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On Sept. 21, 2010, the Pharmacy and Therapeutics Committee met and reviewed several drugs, policies and prior authorization criteria.
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Priority Health has a generic substitution policy that mandates coverage of generics when an A-rated or equivalent generic is available. Currently, if a member or physician requests the brand name product, the member may have to pay the difference in cost between the brand and generic drug cost plus his or her copay. This is known as Member Pay Difference (MPD).
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We listened to our providers’ suggestions and created an improved coordination of care form.
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Accurate billing leads to prompt payment.
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Antibiotics don’t fight viral infections like bronchitis.
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The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program provides comprehensive health services for infants, children and adolescents enrolled in Medicaid.
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Flu vaccine recommendations from the Centers for Disease Control (CDC).
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Priority Health’s Government Programs are promoting the use of birth control to Medicaid members via field service representative phone calls, home visits and letters as part of our maternity followup care, so you may see an increase in patients asking about birth control.
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To avoid antibiotic resistance, treat only proven group A strep with antibiotics.
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When you ask teens if they smoke, don’t forget to ask about smokeless tobacco.
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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. To accomplish this, we conduct a review of the fee schedules annually.
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Our newest commercial benefits plan will be effective Jan. 1, 2011.
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We like to remind you every year of the plan information and programs available to you.
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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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