CPT codes 77301 and 77338 no longer require prior authorization
The two CPT codes listed below no longer require prior authorization:

• 77301
• 77338

They were previously included as requiring prior authorization in our Intensity Modulated Radiation Therapy (IMRT) medical policy (#91633). Because they don't determine medical necessity, we've removed the prior authorization requirement and updated the IMRT medical policy.

30-day pre-claim appeal deadline in effect January 1
Starting Jan. 1, 2023, providers will have 30 days after an authorization denial to submit a Level I appeal.

If that Level I appeal is denied, they’ll have 30 days post denial to submit a Level II appeal.

These deadlines will apply to pre-claim appeals for:

• Commercial
• Individual
• Medicaid
• Medicare post-service pre-claim for in-network providers

We won’t accept appeals submitted after the deadlines.

How to increase authorization approvals

Be sure to submit clinical documentation with every authorization request to support medical necessity. Many authorization denials are due to lack of sufficient documentation submitted with the initial request.

Our GuidingCare guides are a great resource and include a list of documents to consider including with your requests. To get them:

1. Log into your prism account.
2. Click Request an auth under the Authorizations menu.
3. Click Auth request help page.

2023 commercial and Medicare product information; new provider guide available
Our product teams have been busy this year with creating new and enhanced plans and products for members. This year, we’ve created a comprehensive interactive provider guide for important product updates across business lines, with the great new benefits available to members and any changes to existing benefits you'll want to know about.

Download the guide to learn about:

• Two new plans for commercial group members; PriorityGPS and PriorityWell Choice benefits
• Network expansions for MyPriority (individual) members and other updated benefits
• Three news plans and several new benefits for PriorityMedicare members

2023 product guide for providers 

Missed our October VOA? We shared our 2023 product updates in greater detail in this webinar. 

Watch it now 

HRA incentive open to more providers in 2023
In 2023, we’re updating our Healthy Michigan Plan (HMP) measure to open the opportunity to earn the Health Risk Assessment (HRA) incentive payment to more providers, more frequently.

What’s changing?
The HRA incentive will not be part of the PCP Incentive Program (PIP) in 2023. This shift allows us to open the measure and incentive opportunity to independent PCPs. Additionally, Advanced Practice Professionals (APPs) will be eligible to participate in the incentive for the first time.

How can you participate?
To participate in the HRA measure and be eligible for quarterly payments, a credentialed PCP / APP must:

1. Complete the HRA form for eligible HMP members during the 2023 program year. One form per member per year is eligible for the incentive payment.
2. Submit the completed HRA form using CHAMPs or fax. The form must be received no later than 30 days after the end of the quarterly payout period it was completed in.

Find more details in our 2023 HRA technical specifications document.

How much can you earn?
The incentive payment for each eligible form submitted is $25.

What’s the 2023 schedule?
We’ll make quarterly payments in 2023 following this schedule: