02/14/2023

Priority Health Update

Priority Health Managed Care Committee Member

Flora Werle - Cancer & Hematology Centers of West Michigan

2023 PriorityMedicare D-SNP Model of Care training is now available
Providers play an integral role in the care teams that support our dual-eligible special needs members. That’s why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care. Our Model of Care is a quality improvement tool that ensures the unique needs of our D-SNP members are met and describes the processes and systems we use to coordinate their care.

Who needs to complete Model of Care training?
All providers who are part of the Priority Health Medicare Advantage network need to complete training because PriorityMedicare D-SNP uses the Priority Health Medicare network.

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Help your patients battle “winter blues” with our Behavioral Health resources
As we progress through winter, the reality of cold temperatures and shorter days can cause Seasonal Affective Disorder (SAD) or “winter blues” for approximately 5 percent of the U.S. population. Symptoms can include feeling depressed, losing interest in activities, changes in appetite or weight, having issues sleeping and more.

We’re here to help with mental health care needs year-round.
Our Behavioral Health team is available 24/7 to help you and your patients understand their benefits, provide referrals and assist with urgent mental health needs. Below are resources and initiatives we’ve taken to improve the mental health needs of our community.

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2023 fee schedules
We’re in the process of posting 2023 fee schedules, with individual and commercial fee schedules already online. If you’re receiving a claim denial for “Need to rebill as a corrected claim” and you’re billing with a date span, make sure the date span on your claim doesn’t overlap with a previously paid claim. This will prevent unnecessary claim denials and inquiries.

We don’t retroactively adjust any claims paid while we’re loading new rates into our system. To make sure your claims are processed and reimbursed under new rates, you can choose to hold them until you see the new fee schedules posted in prism.

Check for 2023 fee schedules

Medicare & Medicaid quality
Annual CAHPS® Survey coming March 2023

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) is an annual survey conducted from March to June that assesses member experience with their providers and health plan.

How does it work? 
Surveys are sent via email to select members during this time frame. Their responses provide valuable insight so we can make enhancements to our programs and products, and provide new patients with information to help them making informed decisions when selecting providers and health plans.

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Value-based incentive programs
We appreciate your partnership as we work to provide the right care, at the right time, in the right place and at the right cost. We’re continually evolving our incentive programs to help us achieve these goals and to recognize the hard work you do to keep our members healthy. Below you’ll find key incentive program updates and deadlines for the first quarter of 2023.

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Click here to visit the Priority Health Provider News Page for additional updates.