2010 October/November - Physician and Practice Information
Incentive dollars are now available for practice groups that installed an all-payer patient registry by June 30, 2010.
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October is National Breast Cancer Awareness Month so now is a great time to schedule mammograms.
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Enrollment in any of our plans counts toward continuous enrollment measure requirements, as long as the member was in the HMO plan on his or her birth date and had no more than a 45-day gap in coverage in 2010.
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Details of this measure.
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Enter data now in Patient Profile or via the Supplemental Data Worksheet.
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Details of this measure.
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Coming this fall, we will be enhancing our Find a Doctor tool.
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The Patient Protection and Affordable Care Act has brought about many changes to health benefits. While the majority of these changes impact the employer and the insurer, still others are of interest to providers.
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The Federal Trade Commission (FTC) will begin enforcing the Red Flags Rule on Jan. 1, 2011.
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When adding or terminating a provider from your practice, or making an address or phone number change, you may use our Provider Demographic Change Notification form.
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Important reminder when requesting an AIM authorization for a bilateral procedure.
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When a new provider (not currently a participating Priority Health provider) joins your practice our goal is to complete the credentialing process within 45 days.
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Remember to send test results to the primary care provider for the patients you treat as a specialist.
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The 2011 annual enrollment period is fast approaching.
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Encourage your patients to complete an advance directive. Once signed, this should be prominently found in the patient’s medical chart per the CMS requirement. Your Priority Health Medicare patients can find more information here.
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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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To help reverse a decline in Medicaid members receiving needed services, such as a lead test, Priority Health will be sending targeted members a reminder letter promoting a $10 gift card for completing these important preventive health services. We expect this initiative to result in increased requests to PCPs for preventive services.
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Priority Health will reimburse practices achieving PPC-PCMH NCQA recognition.
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To review the CDC’s complete Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.
Billing for flu vaccinations is available in the online provider manual.
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Updates on billing for these screening procedures.
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Through July 2010, several states reported an increase in cases and/or localized outbreaks of pertussis.
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Remember the Tdap vaccine is a Part D covered drug that may be administered by a network provider or obtained from a network pharmacy and administered by a pharmacist registered for vaccine administration.
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The 35th Annual Great American Smokeout is a day set aside to encourage smokers to go 24 hours without smoking.
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All children should have one or more capillary or venous lead blood tests for lead poisoning before their second birthday.
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Falling is the leading cause of fatal and non-fatal injuries in older people. Slipping on ice, stumbling on a stair or a rug, and losing their balance often results in broken bones and cuts, or even traumatic brain injury. However, falls can be prevented.
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Here are the latest updates.
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Effective Oct. 1, 2010, Priority Health began using Express Scripts home delivery pharmacy instead of Walgreens mail service for mail order pharmacy needs.
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View the latest generic drug news.
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Questions or concerns regarding utilization management decisions or processes of Priority Health should be directed to your PAR or the Health Management department at 800 942-4765. Physician and pharmacist reviewers may be used to assist you.
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Priority Health has some drug categories that require a therapeutic trial of a specific drug or drug(s) before authorization will be granted for other medications. This process is commonly referred to as step therapy.
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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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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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