2012 February/March - Physician and Practice Information
Priority Health mails PIP checks by April 15, 2012.
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The PCP Incentive Program manual and useful tools can be found at priorityhealth.com.
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We no longer accept requests for nonadherent patients. We recommend using monthly Filemart
reports to determine member care opportunities in 2012.
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Reviewing the patients on your PCP Incentive Program reports is very important. By making contact
with them now, you’ll have more opportunity to coordinate the needed services.
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To meet the mammogram measure, members must have had a mammogram in either 2011 or 2012. To meet the cervical cancer screening measure, they must have had a screening in 2010, 2011 or 2012.
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These measures require the member to be up to date on or by their 2nd or 13th birthday.
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Annual retinopathy eye exams are covered under the member’s medical benefit. Remember to talk
with your diabetic patients about the importance of this exam and order it during their next visit.
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We have reminder cards you can use when contacting your members needing PCP Incentive
Program services.
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Every year, Priority Health participates in the 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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Judy B. Breuker, CPC, CPMA, CCS-P, CHCA, PCS, CEMC, CHC, CHAP, will offer two sessions of
the ICD-10 class.
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Effective Jan. 1, 2012, we now cover Gardisil for male patients.
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Remember to send your Priority Health member labs and pathology to a participating lab provider for
processing.
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National Alcohol Screening Day is an outreach, education and screening program that raises awareness
about alcohol misuse and refers individuals with alcohol problems for further evaluation.
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Priority Health surveyed PCPs and behavioral health (BH) specialists regarding exchange of information
and care coordination. As in 2010, the goal of the survey was to identify areas of opportunity to promote
coordination of care and support quality improvement.
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It’s common for there to be some confusion among plan providers and members regarding
psychological testing versus neuropsychological testing. The two terms are not always considered
synonymous with regard to provider referrals and oftentimes can be differentiated based on the
provider’s concerns.
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Read the latest in generic drug news.
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Our commercial, Medicaid and Medicare formularies are available through our website.
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As part of our commitment to keep health care affordable, we’ll be encouraging members
taking certain brand-name cholesterol–lowering drugs to discuss generic alternatives with their
PCP.
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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 of medication prescribed for new medications.
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On Jan. 17, 2012, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs,
policies and prior authorization criteria.
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In 2011, we launched an enhanced Medication Therapy Management (MTM) program to all
Priority Health Medicare members.
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Preventive exams for Medicare members are offered under two coding structures.
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Centers for Medicare and Medicare Services (CMS) requires that providers notify Medicare beneficiaries
whenever a service or supply is not covered.
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