2011 October/November - Physician and Practice Information
October is National Breast Cancer Awareness Month, so now is a great time to schedule mammograms and
encourage your patients to do regular breast self-exams.
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Nonadherent members are those who choose not to follow provider recommendations for care. Nonadherent
member exclusion requests are due by December 31, 2011.
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Priority Health uses claims and MCIR data to gather a member’s immunization history.
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While monitoring HbA1c and LDL levels, remember we measure the last test done in 2011.
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When faxing a request for authorization, please do not re-fax the request unless you are sending additional
information.
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In order to expedite the processing of diagnostic imaging exam requests, American Imaging Management (AIM)
will no longer support requests via fax beginning January 1, 2012.
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Effective July 2011, behavioral health providers no longer need prior authorization to provide mental health
intensive outpatient services.
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When requesting behavioral health information on a Priority Health employee, please call our Behavioral
Health department at 800 673-8043 and ask to speak with a clinical case manager.
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We accept mid-level provider billing when serving in two distinct roles.
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The 36th Annual Great American Smokeout, sponsored by the American Cancer Society, is a day
set aside to encourage smokers to go 24 hours without smoking, but you can help your patients
quit whenever they come in for an office visit.
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Judy Breuker will be holding two ICD-10-CM “Training for Coders” seminars.
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These generics are now available.
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Priority Health has some drug categories that require a therapeutic trial of a specific drug(s) before authorization will be granted for other medications. This process is commonly referred to as step therapy.
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Have questions or concerns regarding Priority Health’s utilization management decisions
or processes?
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Pharmacy benefits among Priority Health members can vary based on the coverage purchased.
Here are answers to some frequently asked questions.
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On September 20, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several
drugs, policies and prior authorization criteria.
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Beginning Jan. 1, 2012, Medicare patients who are newly prescribed a generic ACEI or ARB drug
will have their first copay waived.
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The 2012 annual enrollment period is upon us – and it started much earlier this year. People who
want to enroll in a Priority Health Medicare plan can do so from Oct. 15, 2011, to Dec. 7, 2011.
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Patients may not volunteer information about bladder control problems, so be sure to ask them about this
during their yearly exams.
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