Complete Story
08/14/2023
Priority Health Update
Priority Health Managed Care Committee Member
Flora Werle - Cancer & Hematology Centers of West Michigan
Webinar on Disease Burden Capture is Now Available On Demand
Get more from AVWs and CPEs
Tune into our recent webinar designed to help you improve disease burden capture and get the most from your Medicare patients’ Annual Wellness Visits (AWVs) and Comprehensive Physical Exams (CPEs).
The 45-minute webinar features:
- Tips to code to the highest degree of specificity and close gaps in care
- Coding for conditions like cancer and addition
- Epic tools for disease burden capture
- And more
Priority Health Medicare Health Fair on Aug. 24
Current and prospective members are invited to join us in-person for our first annual Medicare Health Fair. It will take place at Priority Health building 3111, 1231 East Beltline Ave NE, Grand Rapids, MI 49525 on August 24, 2023, from 9:00am–2:00pm.
The following will be available:
- Information on all our Priority Health Medicare plans
- Giveaways and information from our vendor partners
- Select health screenings (for current Priority Health members only)
- Light refreshments and games
More information and an RSVP is available on our website.
You may also view and download a flyer for the event here.
FDA withdrawal of approval for Oxandrin® and generic oxandrolone tablets
On Jun. 28, 2023, the FDA announced that it is withdrawing its approval for prescription Oxandrin® and generic oxandrolone tablets due to concerns over safety and effectiveness. The FDA determined that potential problems are sufficiently serious that the drug should be removed from the market.
We’re notifying members
Six Priority Health members are impacted by this FDA withdrawal of approval. We’re sending letters this week to those members, asking that they contact their provider for different treatment options, and to dispose of any current or unused products.
What do providers need to do?
If your patients contact you, work with them on alternative treatment options.
Questions?
More information on this market withdrawal can be found online at federalregister.gov.
Be sure to keep your practice name updated in our Find a Doctor tool
To keep our Find a Doctor tool accurate and to meet our requirements as a health plan, we may remove providers who don’t maintain their information with us. This means you may be removed from Find a Doctor if your practice name doesn’t match the name you answer your phone with or if your other data, like locations or hours of operation, are not accurate.
For example, if you answer the phone as “ABC Family Medicine” your name in Find a Doctor should be “ABC Family Medicine.”
Why is this important?
With an accurate directory, we can:
- Improve the quality of provider data in our directories to help our members—and prospective patients for you—find the care they need.
- Ensure compliance with provider directory regulatory bodies — The Centers for Medicare and Medicaid Services (CMS) requires us to keep this information up to date.
New payment process for BHCC & CM telephone management services
In response to provider requests, we’re updating how we pay PCPs for behavioral health collaborative care (BHCC) services and care management telephone management services for the plan types listed below.
Following the timelines and billing advice listed below, we’ll now pay for the services by paper check, batching payments 60 days at a time.
Q3 Physician and Practice News Digest
Two new chronic pain care management codes now covered to bundle key services for our Medicare and commercial members
By: Dr. David Rzeszutko, MD, MBA, Vice President, Medical and Clinical Operations
Chronic pain patients have medical complexities that drive higher utilization and costs of care compared to the average patient. To help our members with chronic pain get the care and relief they need, we’re covering care management (CM) codes G3002 and G3003 for our group commercial, individual, and Medicare plans, including D-SNP.
See our FAQ for codes G3002 and G3003.
Why is this important?
These new codes enable members with chronic pain to more easily work with their providers to develop and implement care management plans. Covering the codes can also improve payment accuracy and drive down the cost of care for these services through bundling rather than billing a’ la carte.
Click here to visit the Priority Health Provider News Page for additional updates.
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