2012 April/May - Physician and Practice Information
We’ve updated the name of our incentive program: You’ll see that information previously listed as PIP is now being referred to as PCP Incentive Program, or PCP IP.
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Now’s the time to review the list of patients on your PCP Incentive Program (PCP IP) report. By contacting them now, you’ll have more opportunity to coordinate their needed services.
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We have discontinued the $8 high-tech radiology incentive.
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A correction has been made to the table in the PCMH section of the PCP Incentive Program manual.
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Thanks for partnering with us to promote the health and wellness of all patients. We’re now including
the following new measures in our 2012 PCP IP.
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If you have any questions about the PCP Incentive Program, refer to the program manual.
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Changes are effective June 1, 2012 for PCPs and specialists.
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Details of professional and institutional claims codes.
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We encourage you to make coordination of care a routine part of your treatment plan – for all treatments
including Behavioral Health. HIPAA allows providers to share protected health information
for coordination of care.
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Coverage of medical management of obesity is expanding to improve access to care.
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Priority Health nurse case managers will be extending coverage of home blood pressure monitors to a
select group of members. Traditionally, home blood pressure monitors are a non-covered benefit.
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Effective July 1, 2012, brand–name atypical antipsychotics will be subject to a step therapy
requirement for commercial members.
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We’ve put timelines in place for responding to pharmacy prior authorization (PA) requests. These
timelines ensure all members receive appropriate, timely pharmaceutical care based on sound
evidence and individual needs.
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Priority Health members have the option of obtaining their prescriptions from Express Scripts.
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Our formulary is updated up to six times a year and Pharmaceutical Management Procedures
are reviewed annually.
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Remind your patients to show their Priority Health member ID card to their pharmacist every time they fill a
prescription.
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On March 20, 2012, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies
and prior authorization criteria.
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Be sure to read the overview of incentive program measures related to your Medicare patients.
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We’re offering free, in-home health assessments to a select group of Medicare Advantage
members again this year.
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Encourage your Priority Health Medicare Advantage patients* to participate in our free Silver&Fit® fitness program.
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