Virtual Office Advisory webinars | Provider

2024

February 2024 (52 min.)

prism inquiry tips: When and how to reach out to our team
Community Care Management (CCM): Program purpose and highlights, member eligibility criteria, CCM provider partners, new substance use pilot program, referral process and provider resources
New updates to the member Cost Estimator tool: How to access the Cost Estimator tool in prism, provider FAQs, tips on navigating the tool and provider resources
PriorityBABY: Program details, objectives and how to share information with patients.
Medicare and Medicaid quality updates: Medicare annual CAHPS survey updates, 2024 priorities (pharmacy medication adherence, care coordination measures, ECDS and Health Equity) and pregnancy management for Medicaid members
Disease burden management program updates: How ACNs can earn incentives, member qualifications for DBM and provider resources
2024 PCP incentive program updates: 2024 measure updates and our Digital First Strategy
Patient discharge: the new process in prism: How to discharge patients from their assigned PCP in Member Inquiry

April 2024 (54 min.)

Billing and coding policies
Multiple same-day procedure (MSD) billing
Durable medical equipment (DME) billing
Doula billing
Q11 claim denials
Seeing Cigna members in Michigan
How to report additional diagnoses on claims
Hierarchical condition categories (HCC) coding for the disease burden management (DBM) program

2023

December 2023 (44 min.)

prism security: The pSA (prism Security Administrator) process for TPAs (third-party administrators), how practices can determine if their affiliation has a pSA and how to assign PSAs in prism
Pharmacy updates: Formulary changes, coverage changes for Humira and its biosimilars, RSV vaccine coverage updates, pharmacy specialty network updates and continuous glucose monitor core benefit changes
Medicaid quality updates: Information on pre-exposure prophylaxis, chronic kidney disease, doulas, lead screenings in children and vaccines for children
prism inquiry tips: Submitting inquiries using the Clinical Edits dropdown vs. the Other Related Claims dropdown in prism and submitting inquiries for issues impacting more than 10 claims

October 2023 (48 min.)

prism security updates: Information on prism security administrators (pSAs) and how to assign one
Behavioral health updates: information on community care management (CCM) and our self-help mental wellness tool
Medicare quality updates: Q4 member campaigns, 90-day prescription refills and 2024 CMS star ratings updates
2024 Priority Health product updates: Updates on group commercial, individual, Medicare Advantage and D-SNP products
A 2024 PIP program overview: Updates, information about our digital first strategy and a sneak preview of our preliminary 2024 PIP Manual

August 2023 (38 min.)

Behavioral health billing tips: Appeal submissions deadlines, limited license providers, changing locations and more
Coding tips: How to use our Edits Checker tool effectively, virtual care billing, how to submit clinical edits questions and where in prism to review front-end rejections
Appeals tips: An overview of pre- vs. post-claim appeals, what to include with your appeal and working with third-party appeal companies
Pre-service organization determinations: When you need them and how to request them

June 2023 (48 min.)

July 1 formulary changes: Drug and continuous glucose monitor changes
PHE ending: How the end of the Public Health Emergency (PHE) impacted member coverage and virtual care billing
GuidingCare: Updates to our prior authorization portal, including new helpful pop-ups
Medicaid quality updates: Provider resources, Health Risk Assessment (HRA) incentive, lead screenings and immunizations
Medicare quality updates: Health Outcome Survey (HOS), annual physical exams, member rewards, tips for keeping members adherent and more

April 2023 (25 min.)

Top 5 denial reasons of 2023 so far and how to avoid them
How to get your Priority Health questions answered and how to submit your inquiries in prism, with real life examples
Fee schedules and how to find them
Appeals tips for non-contracted Medicare providers
Behavioral health credentialing and enrollment tips

February 2023 (32 min.)

This webinar is a great resource if you’re new to the Priority Health network or need a refresher on the online tools and resources available to help you work with us.

We show you how to:

Get important news and updates
Find the most requested information on our website
Access training videos, news archives and more

2022

December 2022 (35 min.)

January 2023 formulary changes
2023 E/M coding changes
Provider tool spotlight: (1) Best practices for credentialing, billing, payments and prism (2) Top reasons for claims denials and how to avoid them

October 2022 (60 min.)

New products/updates: Regulatory product updates and new, innovative products focused on integrated benefit navigation and accessible care coordination
Medicare quality and 2023 products: End-of-year quality pushes and new Medicare products
2023 PIP updates: Learn about the 2023 program

August 2022 (40 min.)

2021 Quality Awards: Congratulating our winners
prism spotlight: Review how to submit claims and appeals through prism to increase response time
Medicare quality: 2022 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results
Behavioral health: Resources to support your patients during Suicide Prevention Awareness Month
GuidingCare upgrade: Addition of peer-to-peer medical review requests through the authorization portal and the update to InterQual^® 2022 on Aug. 22, 2022
Value-based programs: Key PCP Incentive Program (PIP) updates and deadlines

June 2022 (30 min.)

Pharmacy: July 2022 formulary changes
Quality: Statin Star measures: Tips for keeping patients adherent, monthly adherence reports to get the most from our PCP Incentive Program and ICD-10 codes for intolerance
Risk adjustment: Coding and documentation for depression/major depressive disorder, morbid obesity and social determinants of health, to help you manage better outcomes for your patients and earn incentive dollars through our value-based programs
Member programs: PriorityMOM update

April 2022 (30 min.)

Coding and billing tips for Medicare & Medicaid
Value-based program updates, including PCP Incentive Program (PIP) patient attribution, Patient Profile, PRA attestation and more
RETACRIT supply disruption beginning in May
Right Price Rx, our new pharmacy savings program for commercial members

February 2022 (45 min.)

Medicare 5-Star measures included in the 2022 PCP Incentive Program (PIP)
Credentialing and enrollment in prism
Supporting your patients with eating disorders
Answers to common Cigna Alliance questions
Coding and documentation for diabetes

2021

December 2021 (45 min.)

2022 formulary updates, Medicare and commercial
2022 prior authorization changes
Prism tips
Appeals changes
Coding and documentation for risk adjustment
Prism enhancements coming Dec. 14, 2021

October 2021 (60 min.)

New products and product updates for 2022, including D-SNP plans, commercial products and Medicare products
2022 PCP Incentive Program (PIP) manual and updates
Tips to help close gaps in care this fall
Latest updates for prism

August 2021 (45 min.)

Prism, your new provider account coming this September
Your patients, our members, one Five-Star quality experience
Changes to our musculoskeletal authorization coming Jan. 1, 2022
THC providers can now register for Priority Health onboarding
GuidingCare enhancements coming Aug. 23, 2021
Congratulating our 2020 Quality Award winners

June 2021 (30 min.)

July formulary changes
New provider information form submission process
Updated secure mail options to help you get your questions answered quickly
New tool to help you support patients in finding community resources
New tools for your patients - Priority Health Connect

April 2021 (45 min.)

New provider portal coming soon
Integration with Total Health Care
Reminder: Deadline to join a PO for 2022 PIP participation approaching
Most common causes for billing denials and tips to avoid denials
Benefits of our new APM Roster app for PIP participating providers

February 2021 (45 min.)

Updates to the provider information form used to request demographic changes and more
Coming soon: Automation for provider information submissions
COVID-19 vaccine reimbursement information
2021 PCP Incentive Program (PIP) updates

2020

December 2020 (31 min.)

How to credential nurse practitioners and physician assistants
2021 E/M billing changes
How to review a claim using our claims inquiry tool
Supporting you and your patients during COVID-19 in 2021

November 2020 (54 min.)

January formulary updates
Behavioral health platform: MyStrength
The importance of lead screening
Learn about Priority Health and Cigna Strategic Alliance and serving Cigna members in Michigan
Top causes for billing denials and tips to avoid

October 2020 (1hr. 8 min.)

New products and product changes for 2021, including, updates for our DSNP plans, commercial product updates and Medicare product updates.
2021 PIP manual and updates

September 2020 (25 min.)

The launch of a new authorization tool for inpatient, select procedures, behavioral health, SNFs and home care
How to add providers to PO/PHO contracts
New electronic pharmacy auth tool available: ePA Pharmacy
Tips and tricks for billing Medicare therapy caps

July 2020 (27 min.)

Medicare 5-Star challenge and how to achieve 5-star quality
Our new authorization tool, coming soon for inpatient, select procedures, behavioral health, SNFs and home care
Tips for coding and billing COVID-19 care

May 2020 (36 min.)

July 1 commercial formulary updates
PCP Incentive Program: 2019 and 2020 program updates
COVID-19: Supporting you and providing the latest information

March 2020 (25 min.)

How to use the secure email box to compose messages
Step-by-step guide through the new appeals process
Medicaid programs explained

January 2020 (25 min.)

Upcoming commercial and individual benefit changes for outpatient therapy to prevent post-partum depression
Billing for maternity care
Tips for billing preventive services

2019

December 2019 (18 min.)

Standard practices for billing bilateral diagnoses
Appropriate modifiers to use for Evaluation and Management (E&M) codes
Updates to our provider secure email system and our claims inquiry tool
Provider information form updates: What’s changed and why you should use the updated form

November 2019 (27 min.)

January 2020 formulary changes
Fee schedule updates for hand surgery
Coming soon: View front-end rejections on the provider portal

October 2019 (38 min.)

Medicare Advantage plan updates
Commercial plan updates
New: PriorityMedicare D-SNP plan
2020 individual product updates

September 2019 (56 min.)

January 2020 formulary changes
New 2020 Health Risk Assessment (HRA) and Healthy Behavior requirements for Healthy Michigan Plan members
AHA visits and what you need to do before the year’s end
Tips and tricks for PIP program success

August 2019 (34 min.)

How to term and add providers to your practice using the provider information form
Updating your information on the Council for Affordable Quality Healthcare (CAQH) provider data base
The most common causes for billing denials
Common clinical edits and how you can submit an appeal for review

July 2019 (32 min.)

Community Health Automated Medicaid Processing System (CHAMPS) requirements and enrollment
Key gaps in care
The Medicare 5-Star challenge and how to achieve 5-Star quality
Our annual provider survey
What you need to know about in our recent news highlights