2011 June/July - Physician and Practice Information
Here are the Adolescent immunization measure targets for the 2011 Partners in Performance (PIP) program.
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The rotavirus vaccine administration series is more time sensitive than most vaccine series.
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The 2011 Asthma Care Management measure provides a new way of measuring care of members with
asthma.
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The Follow-up PCP Visits Post-Hospital Discharge measure provides an incentive when members receive
care with their primary care provider within seven days of inpatient discharge when the admit type was
emergent, urgent or trauma.
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Each practice will be given a list at mid-year and year-end of 25 randomly selected patients who had a PCP evaluation and management office visit during the year.
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As part of our ongoing commitment to help you provide the highest quality care to your patients, we’re
creating a seamless, web-based program that will outline quality assurance guidelines for procedures
that require prior authorization or prior notification. We’ll begin testing the program in late July, and
introduce it to the entire network in 2012.
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Getting you the information you need as quickly as possible is what our new interactive voice recognition
(IVR) system is all about.
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Priority Health is committed to partnering with physicians to enable you to deliver the highest quality
care that optimizes clinical outcomes and ensures the best care experience while eliminating avoidable
costs.
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As part of our commitment to accountable care that optimizes clinical outcomes and ensures the
best care experience, we sent cost “Variation Reports” to certain orthopedic, gastroenterology,
cardiologists and ENT specialty practices in March 2011.
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When submitting a corrected claim, remember these things.
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Claim acknowledgment receipts are sent directly to the provider office by fax or email, usually
the same day but no later than the next business day by fax or email.
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As of October 2010, the Department of Community Health (DCH) has mandated that foster care
children enroll in a Medicaid Health Plan.
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Due to health care reform, many patients are no longer liable for a preventive care copay.
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Priority Health places a time-sensitive priority on review of medical prior authorizations that are urgent.
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When scheduling appointments for sick visits or sports physicals (non-covered service), check to see if the patient is due for a preventive visit.
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The Behavioral Health Medical Necessity Criteria and Standards are reviewed annually by the Medical
Affairs Committee, a multidisciplinary group of mental health and substance abuse disorder treatment
providers.
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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 need assistance from our behavioral health staff, here are important numbers and times to know.
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Here are the 2010 Exchange of information survey results.
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Generic Aricept (donepezil) is now available!
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To help people understand the actual costs of prescription drugs, Priority Health has an online tool
called Generic Drugs: A "Class" Act.
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Effective August 1, 2011, Advair and Flovent will be classified as a non-preferred brand (T3) on our
employer-sponsored formulary.
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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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On May 17, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs,
policies and prior authorization criteria.
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As you know, we’re participating in the HEDIS® (Healthcare Effectiveness Data and Information
Set) methodology of collecting, measuring and reporting performance indicators.
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We’re reaching out to members with rheumatoid arthritis (RA) to let them know that a diseasemodifying
anti-rheumatic drug (DMARD) may help relieve their symptoms.
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Some of your patients may understand the benefits of physical activity, but be afraid to exercise because they
think they might fall or hurt themselves.
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