2010 February/March - Physician and Practice Information
Remember that to be included in Partners in Performance (PIP) 2009, all claims must be processed and data entry completed by February 28, 2010.
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We have combined the PIP brochure and technical manual into one document for 2010.
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To exclude a member in 2010, at least two of your attempts to contact the member must be in 2010.
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Our Provider Network Services department has been reorganized for 2010. Effective January 1, 2010, all regions began operating with the same organizational structure, job functions and job titles.
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We're simplifying and streamlining member ID cards for many Priority Health commercial members.
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Patients often make changes to their health insurance coverage on or after January 1.
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More than 6,000 United Auto Workers (UAW) retirees who use Priority Health have new group and contract numbers effective January 1, 2010.
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We wanted to remind you of the objectives of this program and share some successes.
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Annually, Priority Health participates in HEDIS® (Healthcare Effectiveness Data and Information Set) 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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Please contact the Provider Helpline or your PAC immediately when you need to terminate access for an employee in your office.
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Remember to view the Recent Changes section on the left side of the online Provider Manual page for updates to medical policies and billing information.
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We are aware of the high call volume and longer wait times being experienced through the Provider Helpline.
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Effective January 1, 2010, small employer groups (2-50 employees) now have a vision benefit embedded in their medical plan.
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Priority Health has 1,000 laminated pocket guides for flu and pneumonia.
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With the swine flu making headlines, it's important for asthma patients to have a personal Asthma Action Plan.
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Bans on leaded paint and gas have reduced the incidence of dangerous lead levels in kids, but many are still at high risk due to contaminated dust from remodeled homes, glazed pottery, stained glass and hundreds of toys and children's jewelry products sold in many local stores.
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Although the USPSTF recommends adolescents ages 12 to18 receive an annual depression screening from their PCP, less than one-third of PCPs routinely screen their teen patients.
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Priority Health is now offering telemonitoring services to heart failure (HF) patients who are at high risk of admission or readmission for exacerbations of their condition. Telemonitoring uses home monitoring equipment to measure a patient's weight, blood pressure and pulse, and transmits clinical data to a registered nurse in a central location.
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STIs can be treated with antibiotics, but left untreated can cause pelvic inflammatory disease (PID), infertility or ectopic pregnancy.
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Please make sure that these diagnoses are being billed correctly. We've recently identified cases where diagnoses are being billed incorrectly.
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Priority Health does not reimburse separately for G0101 or Q0091 when they are performed for indicated purposes on the same date as a problem-oriented E&M service.
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Centers for Medicare and Medicaid Services (CMS) has defined two CPT codes for documenting and billing tobacco use cessation counseling services.
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As proposed in July, CMS has announced that they're eliminating the use of all consultation codes effective January 1, 2010.
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Enter Claim Frequency Type Code (billing code) 7 (for a replacement/correction) or 8 (to void a prior claim) in the 2300 loop in the CLM*05 03.
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The largest source of paper claims are those that contain COB information. We do not require you to submit COB claims on paper; in fact, we prefer electronic submission.
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Remember to contact us when you have demographic changes to your practice. If our system is not updated with current provider information, claims payment may be delayed.
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When you notice Wellcentive data issues please first contact Wellcentive to make sure the data was present and transmitted.
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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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Filed under
Priority Health is pleased to continue to support advancements in primary care into 2010 and will reward practices that have been recognized by the National Committee for Quality Assurance (NCQA).
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Generic Valtrex (valacyclovir) is now available!
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On November 17, 2009, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria. The following information summarizes the recommendations made at the P&T meeting.
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Our commercial, Medicaid and Medicare formularies are available through our website.
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Priority Health members have the option of obtaining their prescriptions from Walgreens Mail Service.
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In an effort to lessen the likelihood of waste associated with prescriptions, we encourage you to be judicious in the quantity of medication prescribed for new medications.
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Effective November 1, 2009, in order to help our members receive an initial evaluation more quickly, we no longer require a behavioral health provider to be identified in the authorization.
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Because the member doesn't have to select a behavioral health provider before we issue authorization, we don't know who they have chosen.
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Members are still required to contact Priority Health to get authorization for their initial evaluation.
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Effective December 1, 2009 we implemented the American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC) for the treatment of substance-related disorders.
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We would like to remind you that outpatient mental health and substance abuse therapy sessions do not require prior authorization. This means you will not need to call us to approve outpatient mental health or substance abuse therapy sessions for 2010.
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As of January 13, 2010 behavioral health copays and coinsurance details for Priority Health members are available through our online Member Inquiry tool.
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