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Priority Health
Priority Health News Get ready for a new auth tool Register today for webinar training to learn how to use the new tool, launching in September | more Complete your PriorityMedicare D-SNP Model of Care training before Dec. 31 Reminder: If you see D-SNP patients, complete Model of Care training | more Authorizations Authorization is...
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Payer Updates On September 14, we’re launching GuidingCare, a new authorization tool that will replace Clear Coverage. Make sure you’re ready to successfully request authorizations this fall by registering for webinar trainings. What steps do you need to take to ensure success? The GuidingCare tool is for procedure, inpatient, behavioral health, home care and skilled...
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We’re improving our peer-to-peer process with a single phone line to help you work with us quickly and easily. Effective July 1, you will have one phone number to call if you want to schedule a peer-to-peer conversation with a medical director for inpatient and outpatient services. The phone number is 616.464.8432. Additionally, we’ve expanded...
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Background information We know how important it is to have the Priority Health members you see assigned to your practice. That’s why we’re making changes based on your feedback to improve our member assignment. This spring, we’ll review our HMO and POS members’ assigned Primary Care Provider (PCP) compared to the PCP they’re seeing based...
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In July and January of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs. So far in 2020, we’ve added 45 new drugs to the formulary. We’ve also made positive changes (reduced tier or removal of authorization...
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Administrative details – (pg. 11) Measure rounding – PIP measures round up if the score is within 0.5% of the target. Example: If the score is 89.4, it will round to 89. Alternatively, if the score is 89.5, it will round to 90. PPACA – (pg. 12) The Patient Protection and Affordable Care Act (PPACA),...
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Documentation for risk adjustment Quick reference guide
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