01/19/2022

Priority Health Update

Priority Health Managed Care Committee Member

Flora Varga, Cancer & Hematology Centers of West Michigan

Our Clinical Pharmacists are Calling Some of Your Patients About Medication Adherence

Our clinical pharmacists are reaching out to your patients to improve their medication adherence. This work helps to improve our CMS 5-Star Rating. Adherence to Medicare 5-Star related drugs (diabetes, cholesterol, and high blood pressure) are “triple weighted” measures that comprise ~15% of our overall Star Rating.  Read about what's changing, CLICK HERE

Use Place of Service Code 10 for Virtual Services Provided in the Patient's Home

As of Jan. 1, 2022, we now accept two place of service codes for virtual services, to better reflect where your patients receive these services:

POS 02, which had been used for virtual services provided anywhere, is now specifically for virtual services performed with a patient who’s in a location other than their own home
POS 10 is a new place of service code to use for virtual services performed with a patient who’s in their own home
The above ways you bill virtual services apply to our commercial, Medicaid and Medicare members. Both POS codes will reimburse at the higher non-facility rate. Be sure to include appropriate modifiers when applicable.

Find more information on virtual visits and telehealth

Appeals Tips for Medicare Non-Contracted Providers

If you’re a non-contracted provider making a post-service Medicare appeal, below are a few tips, tricks and key pieces of information from our Reimbursement team to help you navigate the two levels of the Medicare Appeals process.

What’s an appeal/reconsideration?  READ MORE

New Commercial plan - PriorityAllowance

In January 2022*, we’re introducing PriorityAllowance. This new product gives each member an allowance to make health care more affordable, promote good health, and remove barriers to care. When the member has an allowance available, we pay the claim – including the member’s portion.

*Available for small groups. PriorityAllowance will be available to large group employers in spring 2022.

Reminder: THC members newly transferred to Priority Health Choice Medicaid may have benefit changes

Read more about 2022 Commercial and Medicare Product Information