2010 June/July - Physician and Practice Information
Watch your mail for the first 2010 BMI Partners in Performance (PIP) listing.
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To meet this measure, a practice must obtain a 50 percent rate of electronic prescribing.
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Although Admits/1000 and High Tech Radiology (HTR) aren't PIP measures in 2010, we're still reporting them on the monthly Key Indicator Report (KIR) under "other efficiency" on the right side of the report.
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Incentive dollars are available for practice groups that have installed an all-payer patient registry by June 30, 2010, with additional incentives for groups implementing meaningful use of the registry by Sept. 30, 2010.
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You can find the 2010 PIP Technical Manual in the Performance Program section of the Provider Manual on our website. All measure code sets are now located in the back of the manual.
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This is a reminder that retinal eye exams for diabetic members are covered under the medical benefit and don't require a vision rider policy.
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Priority Health hosted the spring Patient-Centered Medical Home Learning Collaboratives April 20 and 21 in Grand Rapids.
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We are continuing our commitment to paying a 12 month infrastructure support fee to practices successful in their application to NCQA for Physician Practice Connections (PPC®) -PCMHTM recognition.
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As the new law takes effect, we'll keep you informed. We've dedicated a page on priorityhealth.com as a "resource center" for health care reform.
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This course is designed for those who want an intensive preparation course to prepare for the national coding certification.
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Effective June 1, 2010, the federal government has mandated that all Medigap plans include enhanced hospice coverage — after Medicare pays 100 percent of member hospice care costs, Medigap plans will cover the respite care and prescription drugs associated with hospice care.
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The Complexity of Care Incentive program will continue in 2010.
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President Obama signed the Health Information Technology for Economic and Clinical Health Act ("HITECH Act") into law on February 17, 2009, as part of the American Recovery and Reinvestment Act of 2009 (economic stimulus package). Most of the changes related to HIPAA business associates went into effect on February 17, 2010.
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Effective for service dates on or after April 1, 2010, medications within the listed drug classes are billed at the pharmacy directly to the MDCH-contracted Pharmacy Benefit Manager (PBM) — First Health Services Corporation.
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Generic Cozaar (losartan) and Hyzaar (losartan/HCTZ) are now available! Losartan is the first angiotensin receptor blocker (ARB) to become available as a generic.
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On March 16, 2010 the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria.
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Read the latest update on generics.
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If you're short on time, you'll really appreciate the convenience of MobileCME solutions from Epocrates!
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Generic drugs: To help people understand the actual costs of prescription drugs, Priority Health has an online tool.
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The following therapeutic drug classes will be carved out April 1.
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This fall A Matter of Balance class will be offered to Priority Health members, ages 60 and older.
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One in four women in the United States dies from heart disease. View the American Heart Association Guidelines for Heart Disease and Prevention in Women, and patient education on blood pressure, cholesterol and more.
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Details of the 2010 Alliance for Immunizations toolkit.
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Colorectal cancer ranks third in incidence and second in cause of cancer death for both men and women.
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While conscious sedation is covered as part of a preventive colonoscopy, other anesthesia services are subject to higher copays and deductibles.
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The Centers for Disease Control and Prevention suggests these talking points when discussing developmental delays with parents.
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Read more about this opportunity.
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The state of Michigan's Childhood Lead Poisoning Prevention Program has enough funding for one more year. Take advantage of the following FREE resources while they are still available!
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The Asthma Network of West Michigan has this message for providers regarding the treatment of members with asthma.
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Medicaid highlights.
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Here are the latest updates.
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MIChild is a health insurance program for uninsured children, provided by Priority Health and other plans in Michigan.
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Upon completion of the OB Enrollment/Auth form in the first 12 weeks of pregnancy, your patient is automatically enrolled in our maternity support program.
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Coverage criteria for the treatment of psoriasis have been updated in the Skin Conditions medical policy to include phototherapy (UVB) in a provider setting.
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The Michigan Department of Community Health has a new immunization website designed for teens, parents and health care personnel at michigan.gov/teenvaccines.
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The Behavioral Health Medical Necessity Criteria and Standards are reviewed annually by the Behavioral Health Committee, a multidisciplinary group of mental health and substance abuse disorder treatment providers.
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If you need assistance from the Behavioral Health staff, please call 616 464-8500 or toll free at 800 673-8043. We can be reached Monday through Friday, 8 a.m. to 5:30 p.m. In addition, we're available for emergency calls after hours and on weekends by calling one of the numbers above.
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In order to serve the best interests of our members, Priority Health will make utilization decisions that are fair and consistent.
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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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