2011 February/March - Physician and Practice Information
Remember, all services completed in 2010 must be entered via Patient Profile or the Supplemental Data Spreadsheet by Feb. 28, 2011.
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We will mail PIP checks by April 15, 2011.
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We generate PIP reports each month.
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The 2011 PIP Manual is available online along with other program resources. Remember, to access PIP information online you need to be logged in.
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We are committed to working with you to help provide excellent outcomes and a good patient
experience. At the same time, we have a responsibility to control costs by avoiding waste and
duplication in health care services.
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Priority Health has long supported initiatives focusing on patient care. At their core, our Partners in Performance (PIP) program and patient-centered medical home (PCMH) efforts seek to improve patient care. So we’re putting a new name to our long-standing practices to better demonstrate the links connecting these initiatives.
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Priority Health follows CMS guidelines mandating that all medical records submitted for medical review must be signed by the practitioner. A medical record that doesn’t contain a valid signature may result in claim denials or recovery of overpayments. More information.
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We have updated the authorization review process to provide quicker response times to requests for prior authorization.
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Priority Health has introduced a new rider option for large group employers (50+ employees). Employers may now purchase a benefit coverage rider for autism spectrum disorders.
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Every year 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 remember to update your Tax ID on AIM’s website so you can continue to request and obtain authorizations online for high-tech imaging. Log in to update your tax ID online. If you need assistance, please contact your provider account coordinator (PAC).
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Judy Breuker, CPC, CPMA, CCS-P, CHCA, PCS, CEMC, CHC, CHAP, will hold two upcoming classes at Priority Health.
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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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Priority Health Government Programs has fully implemented the SNAF process in our Health Management department. This applies to Priority Health Medicaid.
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Priority Health is proud to announce the expansion of its provider partnerships with:
- Emergency Care Specialists (ECS), a 78 physician emergency medicine provider group
- Mt. Clemens Regional Medical Center, a 288-bed acute care hospital in Macomb county
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The new codes, 90460-90461 are specific to members birth to 18 years old receiving counseling for each vaccine component.
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Read the lastest updates on generics.
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Effective April 1, 2011, non-sedating antihistamines (NSAs) and brand-name proton pump
inhibitors (PPIs) will be excluded from coverage for commercial and Medicaid members.
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We’re launching an enhanced Medication Therapy Management (MTM) program to all Priority
Health Medicare members.
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As part of our commitment to keep health care affordable, Priority Health will be encouraging
members taking certain brand-name drugs to discuss generic alternatives with their PCP.
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On Nov. 16, 2010 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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In an effort to lessen the likelihood of waste associated with prescriptions, we encourage you
to be judicious in the quantity prescribed for new medications.
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As of Jan. 1, 2011, CMS retired Medicare influenza vaccine code 90658. Priority Health
will be following this code change as well.
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Patients may not volunteer information regarding bladder control, so every year physicians
should ask patients about this.
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Clinical guidelines related to fall prevention recommend that on a yearly basis
all adults over the age of 65 years should be asked by a health care provider whether they
have had a fall; among those who report a fall, efforts should be directed at determining the
causes of falls and providing strategies to reduce future fall risks.
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A Priority Health nurse will make calls to your patients on these HEDIS topics.
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Priority Health has a five-step approach algorithm to manage hyperglycemia in your patients
with Type 2 diabetes.
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The American Heart Association/American Stroke Association (AHA/ASA) has released
new guidelines for the primary prevention of stroke.
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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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Priority Health Medicaid members are eligible to earn a $10 incentive for these actions.
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Under the Vaccines for Children (VFC) program, free vaccines are available to children up to
age 19 under certain conditions.
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Include discussion of e-cigarettes when counseling adolescent patients who smoke. E-cigarettes,
or electronic nicotine delivery devices, are being marketed on the Internet as safer (no
secondhand smoke / lower nicotine absorption). FDA laboratory analysis suggests even those
labeled nicotine free deliver trace amounts of diethylene glycol and varying amounts of nicotine
in each puff. Users report they aid in cessation, despite lack of proof. (The FDA warns against
their use.)
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Two-thirds of Americans are overweight or obese and struggling with weight loss. Research
shows obese patients feel stigmatized in health care settings, which often occurs unintentionally.
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The CDC’s Screen for Life campaign has educational materials (available in English and Spanish) to motivate
patients to talk to you and get screened for colorectal cancer.
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The new codes, 90460-90461 are specific to members birth to 18 years old receiving counseling for each vaccine component.
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April 7, 2011 is National Alcohol Screening Day (NASD), an annual outreach, education, and screening program that raises awareness about alcohol misuse and refers individuals with alcohol problems for further evaluation.
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Register for your online account today!
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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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