Physician and Practice Information newsletter from Priority Health

Medicaid fee schedule changes

Wed, 11 Apr 2012 17:00:21 -0400

Changes are effective June 1, 2012 for PCPs and specialists.

Print this issue

Wed, 11 Apr 2012 10:37:51 -0400

Here's a PDF file of this April-May Physician and Practice Information newsletter to download and/or print.

Improved health through Silver&Fit

Tue, 10 Apr 2012 14:01:04 -0400

Encourage your Priority Health Medicare Advantage patients* to participate in our free Silver&Fit^® fitness program.

Free health assessments continue

Tue, 10 Apr 2012 13:58:32 -0400

We’re offering free, in-home health assessments to a select group of Medicare Advantage members again this year.

Incentive program measures

Tue, 10 Apr 2012 13:55:11 -0400

Be sure to read the overview of incentive program measures related to your Medicare patients.

P&T changes

Tue, 10 Apr 2012 13:53:07 -0400

On March 20, 2012, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria.

ID cards

Tue, 10 Apr 2012 13:50:48 -0400

Remind your patients to show their Priority Health member ID card to their pharmacist every time they fill a prescription.

Drug formulary and pharmacy management procedures

Tue, 10 Apr 2012 13:48:07 -0400

Our formulary is updated up to six times a year and Pharmaceutical Management Procedures are reviewed annually.

Mail order prescriptions

Tue, 10 Apr 2012 13:45:45 -0400

Priority Health members have the option of obtaining their prescriptions from Express Scripts.

Pharmacy PA timelines: Urgent review available when needed

Tue, 10 Apr 2012 13:27:18 -0400

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.

Step therapy for atypical antipsychotics begins July 1, 2012

Tue, 10 Apr 2012 10:55:18 -0400

Effective July 1, 2012, brand–name atypical antipsychotics will be subject to a step therapy requirement for commercial members.

Coverage of home blood pressure monitors

Tue, 10 Apr 2012 10:51:27 -0400

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.

Medical management of obesity

Tue, 10 Apr 2012 10:47:23 -0400

Coverage of medical management of obesity is expanding to improve access to care.

Coordination of care for Behavioral Health/PCPs

Tue, 10 Apr 2012 10:44:32 -0400

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.

EDI diagnosis code limits

Tue, 10 Apr 2012 10:39:45 -0400

Details of professional and institutional claims codes.

Questions?

Tue, 10 Apr 2012 10:32:36 -0400

If you have any questions about the PCP Incentive Program, refer to the program manual.

Incentives for Medicare measures

Tue, 10 Apr 2012 09:57:44 -0400

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.

PCP Incentive Program manual correction

Tue, 10 Apr 2012 09:47:02 -0400

A correction has been made to the table in the PCMH section of the PCP Incentive Program manual.

High-tech radiology incentive

Tue, 10 Apr 2012 09:41:25 -0400

We have discontinued the $8 high-tech radiology incentive.

Maximize your incentives: Make contact with your patients

Tue, 10 Apr 2012 09:35:41 -0400

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.

2012 Incentive Program now called PCP IP

Thu, 05 Apr 2012 13:48:25 -0400

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.

Print this issue

Tue, 07 Feb 2012 13:51:50 -0500

Here's a PDF file of this February-March Physician and Practice Information newsletter to download and/or print.

Advance Beneficiary Notification of Noncoverage

Tue, 07 Feb 2012 09:56:08 -0500

Centers for Medicare and Medicare Services (CMS) requires that providers notify Medicare beneficiaries whenever a service or supply is not covered.

Medicare preventive services updates

Tue, 07 Feb 2012 09:44:13 -0500

Preventive exams for Medicare members are offered under two coding structures.

Medication Therapy Management program for Medicare patients

Thu, 02 Feb 2012 16:19:07 -0500

In 2011, we launched an enhanced Medication Therapy Management (MTM) program to all Priority Health Medicare members.

January 2012 P&T updates

Thu, 02 Feb 2012 16:15:24 -0500

On Jan. 17, 2012, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria.

Reduce medication waste

Thu, 02 Feb 2012 16:12:41 -0500

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.

Generic initiatives planned for 2012

Thu, 02 Feb 2012 15:49:08 -0500

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.

How to obtain a copy of our formulary

Thu, 02 Feb 2012 15:36:52 -0500

Our commercial, Medicaid and Medicare formularies are available through our website.

Generic drug news

Wed, 01 Feb 2012 16:56:08 -0500

Read the latest in generic drug news.

Understanding psychological testing versus neuropsychological testing

Wed, 01 Feb 2012 16:50:31 -0500

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.

2011 behavioral health provider and PCP survey

Wed, 01 Feb 2012 16:38:38 -0500

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.

National Alcohol Screening Day^® is April 5, 2012

Wed, 01 Feb 2012 16:35:59 -0500

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.

Participating labs

Wed, 01 Feb 2012 16:21:28 -0500

Remember to send your Priority Health member labs and pathology to a participating lab provider for processing.

Gardisil for males

Wed, 01 Feb 2012 16:11:51 -0500

Effective Jan. 1, 2012, we now cover Gardisil for male patients.

Principles of ICD-10-CM coding class

Wed, 01 Feb 2012 16:04:53 -0500

Judy B. Breuker, CPC, CPMA, CCS-P, CHCA, PCS, CEMC, CHC, CHAP, will offer two sessions of the ICD-10 class.

"Make your move" cards

Wed, 01 Feb 2012 15:52:56 -0500

We have reminder cards you can use when contacting your members needing PCP Incentive Program services.

2012 HEDIS reviews

Wed, 01 Feb 2012 15:51:10 -0500

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.

Diabetic eye exams

Wed, 01 Feb 2012 15:48:25 -0500

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.

Lead screenings and immunizations

Wed, 01 Feb 2012 15:46:50 -0500

These measures require the member to be up to date on or by their 2nd or 13th birthday.

Mammograms and cervical cancer screenings

Wed, 01 Feb 2012 15:43:41 -0500

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.

Make contact with your patients

Wed, 01 Feb 2012 15:39:09 -0500

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.

Nonadherent requests retired

Wed, 01 Feb 2012 15:26:04 -0500

We no longer accept requests for nonadherent patients. We recommend using monthly Filemart reports to determine member care opportunities in 2012.

PCP Incentive Program 2012 materials available

Wed, 01 Feb 2012 15:22:07 -0500

The PCP Incentive Program manual and useful tools can be found at priorityhealth.com.

2011 Partners in Performance (PIP) settlement

Wed, 01 Feb 2012 15:20:23 -0500

Priority Health mails PIP checks by April 15, 2012.

Information available online

Fri, 09 Dec 2011 13:24:00 -0500

Every year we like to remind you of the plan information and programs available to you. The listings here highlight these areas and direct you to more information available online.

Print this issue

Fri, 09 Dec 2011 10:30:00 -0500

Here's a PDF file of this December-January Physician and Practice Information newsletter to download and/or print.

Pneumonia vaccines for Medicare patients

Wed, 07 Dec 2011 15:06:41 -0500

Please make sure your patients who are 65 or older, especially those who have an underlying condition or respiratory disease, have had a pneumonia vaccine.

Medicare: High risk meds not covered in 2012

Wed, 07 Dec 2011 15:01:55 -0500

Effective Jan. 1, 2012, high-risk medications (HRMs) will be removed from the Priority Health Medicare formulary.

P&T Committee updates

Wed, 07 Dec 2011 14:56:35 -0500

On Nov. 15, 2011, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria.

Physician and Practice Information newsletter from Priority Health

Medicaid fee schedule changes

Print this issue

Improved health through Silver&Fit

Free health assessments continue

Incentive program measures

P&T changes

ID cards

Drug formulary and pharmacy management procedures

Mail order prescriptions

Pharmacy PA timelines: Urgent review available when needed

Step therapy for atypical antipsychotics begins July 1, 2012

Coverage of home blood pressure monitors

Medical management of obesity

Coordination of care for Behavioral Health/PCPs

EDI diagnosis code limits

Questions?

Incentives for Medicare measures

PCP Incentive Program manual correction

High-tech radiology incentive

Maximize your incentives: Make contact with your patients

2012 Incentive Program now called PCP IP

Print this issue

Advance Beneficiary Notification of Noncoverage

Medicare preventive services updates

Medication Therapy Management program for Medicare patients

January 2012 P&T updates

Reduce medication waste

Generic initiatives planned for 2012

How to obtain a copy of our formulary

Generic drug news

Understanding psychological testing versus neuropsychological testing

2011 behavioral health provider and PCP survey

National Alcohol Screening Day® is April 5, 2012

Participating labs

Gardisil for males

Principles of ICD-10-CM coding class

"Make your move" cards

2012 HEDIS reviews

Diabetic eye exams

Lead screenings and immunizations

Mammograms and cervical cancer screenings

Make contact with your patients

Nonadherent requests retired

PCP Incentive Program 2012 materials available

2011 Partners in Performance (PIP) settlement

Information available online

Print this issue

Pneumonia vaccines for Medicare patients

Medicare: High risk meds not covered in 2012

P&T Committee updates

National Alcohol Screening Day^® is April 5, 2012