Search

Recent Posts

Provider Monthly:  MassHealth discharge planning, Medicare balance, and recognizing National Diabetes Awareness Month during November 2021

Featured Story:

Learn about the program designed to prevent or delay the development of diabetes

AllWays Health Partners and The Massachusetts General Hospital Diabetes Center offer the Path to Lifestyle Change program to help our members lose weight—and delay or prevent type 2 diabetes. The Path to Lifestyle Change was created and is being directed by Linda Delahanty, MS, RD, the Director of Nutrition and Behavioral Research at the Mass General Diabetes Center. In recognition of National Diabetes Awareness Month, continue reading to learn more about Linda’s passionate commitment to supporting anyone impacted by diabetes.

DSC_0037

Keep reading

To view last month's newsletter or any previous month, visit our Admin Newsletter Archive.

In this issue:

  • MassHealth discharge planning to support members experiencing or at risk of homelessness
  • Medicare balance
  • Return to pre-pandemic rates for telehealth services
  • 2022 product trainings
  • Reminder if your practice provides PANS/PANDAS services
  • Provider service line wait times 
  • Medical policies
  • Code updates
  • Drug updates

MassHealth discharge planning to support members experiencing or at risk of homelessness

MassHealth worked in coordination with the Department of Housing and Community Development, the Interagency Council on Housing and Homelessness, and other departments within the Executive Office of Health and Human Services to better align expectations for Acute Inpatient Hospitals, Freestanding Psychiatric Hospitals, and emergency shelters in order to decrease the number of people who are discharged from healthcare facilities directly to homeless shelters. To assist discharging hospitals and shelters MassHealth has developed new tools and guidance, all of which are available on a new website: Helping Patients who are Homeless or Housing Unstable. 

MassHealth also published “Discharge Planning to Support Members Experiencing or at Risk of Homelessness” bulletins for Acute Inpatient Hospitals, Freestanding Psychiatric Hospitals, and Managed Care Entities. The bulletins describe discharge planning procedures designed to enable hospitals to identify MassHealth members experiencing or at risk of homelessness in a timely fashion after admission and to ensure that such members have access to the post-hospital care, including an appropriate place to live, or other services that they need.


Medicare Balance

  • AllWays Health Partners Medicare Balance plan provides secondary coverage to Medicare—all members are required to have both Medicare Parts A and B.
  • Medicare Balance does not have a provider network, so members may choose to see any doctor, anywhere in the nation, who accepts Medicare! And don’t worry about providing referrals—members don’t need a referral to see a specialist.
  • For billing purposes, Medicare should be listed as the member’s primary coverage and AllWays Health Partners Medicare Balance as their secondary coverage.
  • AllWays Health Partners Medicare Balance pays any remaining deductible or coinsurance amount not covered by Medicare, less any applicable copays required by the plan design (this will vary by employer)
  • Below is a sample of the ID card members of Fallon Medicare Plus Freedom will present when accessing your services. (attached to email if you want to include)

Read More

Topics: Providers

Provider Monthly: New behavioral health resource webpage, Allies update, and recognizing Breast Cancer Awareness Month during October 2021

Featured Story:

Meet Dr. Amy Comander MD, Director of Breast Oncology and Survivorship at the Mass General Cancer Center in Waltham and Newton-Wellesley Hospital

Dr. Amy Comander specializes in the care of women with breast cancer at the Mass General Cancer Center in Waltham and Newton-Wellesley. In recognition of National Breast Cancer Awareness Month, learn more about Amy and the life-changing work she participates in each day to support those impacted by a breast cancer diagnosis.
20210501 Amy Comander 2052 (Square Print)

Keep reading

To view last month's newsletter or any previous month, visit our Admin Newsletter Archive.

In this issue:

  • NEW behavioral health resource webpage for patients
  • On-demand webcast by Optum
  • Urgent authorization requests
  • PANS/PANDAS services
  • Allies update
  • EFT and ERA payment changes
  • Hospital inpatient utilization report
  • Provider portal access for your entire team
  • Revised medical policies
  • Code updates
  • Formulary updates

New behavioral health page for patients

Mental health is a key part of our overall well-being—and we're here to help. Encourage your patients to visit allwayshealthpartners.org/members/behavioral-health for useful resources to help them get the support they need to manage their mental and behavioral health care.


On-demand webcast by Optum

Sign up now for Behavioral Health Identification, Treatment and Referral in Primary Care - A 3-Part On-demand Learning Series from Optum (earn up to 3 credits)


Read More

Topics: Providers

Provider Monthly: Interqual updates, editing system upgrade, and recognizing national recovery month in September 2021

Featured Story:

Meet Barry Shelton: peer recovery coach at AllWays Health Partners

Did you know that AllWays Health Partners was one of the first health plans in the country to have peer recovery coaches on staff? Seeing as September is National Recovery Month, we want to take this timely opportunity to share some of the life-changing work of our Peer Recovery Coaches and the impact that has on members' access to the different pathways of recovery. National Recovery Month

Keep reading

To view last month's newsletter or any previous month, visit our Admin Newsletter Archive.

In this issue:

  • On-demand webcast by Optum
  • AllWays Health Partners’ Drug fee schedules to be updated
  • Claims editing system upgrade
  • InterQual 2021 Updates
  • Cardiac Imaging- change in PA status
  • COVID-19 specimen collection
  • Urgent authorization requests
  • Revised medical policies
  • Code updates
  • Formulary updates

Read More

Topics: Providers

Provider Monthly: New authorization tool, updated drug fee schedules, and revised medical policies in August 2021

Featured Story:

Five tips to ensure providers’ success with new Authorization Process for High-Tech & Cardiac Imaging

Providers: effective July 18, 2021, there was a new Authorization Process for High-Tech & Cardiac Imaging implemented on our authorization tool. To ensure you're maximize the benefits of this new tool, we've outlined some tips below to reduce your administrative burden and speed up authorization approvals.

  1. Select the appropriate requested service
    When you are using the prior authorization tool, confirm that you are selecting the proper service—and not choosing the default of other medical. Indicating an accurate service that corresponds with your request only speeds up the process.

happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139 (1)

Keep reading

To view last month's newsletter or any previous month, visit our Admin Newsletter Archive.

In this issue:

Read More

Topics: Providers

Provider Monthly: New system upgrade, a message for providers enrolled during COVID and the latest clinical guidelines for July 2021

Featured Story:

Pediatrician Perspective Part 1: should I vaccinate my child?

Now that the FDA has authorized vaccination for adolescents ages 12-17, parents have questions. After surveying some of our members about concerns and hesitancy, we compiled some of the most common questions to ask Pediatrician and Medical Director at AllWays Health Partners, Dr. Lisa M. Scarfo, MD. Continue reading for part 1 of 2 to learn what Lisa had to say about getting kids vaccinated, the impact this year has had on students' development, and how to get adolescents socializing with their friends again safely.doctor-in-face-mask-giving-vaccine-to-little-boy-who-came-to-the-picture-id1298103455

Read More

Provider Monthly: The all-new AllWays member app, an upcoming webinar, and important reminders for providers in June 2021

As you probably noticed from our email, they way we're sharing our newsletter has a new look and feel based on your feedback. If you'd like to share your thoughts on on similar items in the future, join our online advisory group today.

Featured Story:

Do your patients know about the all-new AllWays member mobile app?

Now, your patients can manage their healthcare on the go with our all-new AllWays member mobile app. The easy-to-use app simplifies searching for providers, accessing plan information, and contacting our customer support team. To learn about all the features designed to improve your patients' healthcare experience, visit allwayshealthpartners.org/memberapp

In this issue:

  • Upcoming webinar: new authorization process for high-tech and cardiac imaging
  • Message from the Pharmacy Team
  • New member search tool
  • Revised medical policies
  • Code updates
Read More

Answering patients' vaccine questions, updated policies, and important reminders for providers this month: May 2021

Featured story:

Answering patients' questions about the vaccine

No matter your specialty—your patients may have questions about the COVID-19 vaccine. In a recent member survey, 74% of respondents marked their PCP or other doctors as the most reliable vaccine information source. Now that anyone aged 16+ is eligible to receive a COVID-vaccine in Massachusetts, patients are looking to providers for guidance.

We encourage you to visit our vaccine resource page for the most updated materials and visit our Best Practice blog for helpful tips. Below you'll find three of our most recent articles:

In this issue:

  • Tumor treating fields InterQual criteria
  • High-tech and cardiac imaging
  • United claims in Massachusetts and Rhode Island
  • Medical policy updates
  • Revised medical policies
  • Forumulary updates
  • CPT code updates

Read More

New vaccine resource and important reminders for providers this month: April 2021

Featured story:

Browse our new vaccine resource page 

Massachusetts will open the final phase of the vaccine rollout to the general public on April 19, 2021. If patients are hesitant to get the vaccine, we've created a dedicated COVID-19 vaccine page with a curated collection of resources for you and your patients: 

Key messages to share with patients from the CDC

In this issue:

  • Medications obtained through the medical benefit
  • New products
  • New vaccine resource page
  • New guidelines
  • Hospital inpatient utilization report
  • New, revised, and retired medical policy updates
  • New codes
  • CPT code updates
  • Drug code updates

Read More

Vaccine communications, new policies, and important reminders for providers this month: March 2021

Featured story:

COVID-19 vaccine communications

As COVID-19 vaccine distribution and administration accelerate across our state and nation, we are providing a few updates for you to share with your patients. First, there remain many myths and questions circulating in the community, and we want to ensure our customers and members have the facts about safe and effective vaccines. Addressing vaccine myths and providing the facts to instill confidence is critical to our shared success. We are joining our parent organization, Mass General Brigham, in supporting a critical state campaign, Trust the Facts. Get the Vax campaign, to educate the public and our members on the safety and efficacy of the COVID 19 vaccine.

In addition to vaccine safety, our vaccine communications tie in access, equity, and ongoing prevention as the phased approach outlined by the state continues to move forward. To remind members 75 and older to make their vaccine appointments, we are currently using proactive phone outreach. We are also sending individual text message to members 65 and older as well as those with two or more co-morbidities. Next, we’ll be sending target letters guided by vaccine phases.

We will continue to update you with the latest information as it becomes available.

In this issue:

  • COVID-19 vaccine communications
  • SPEAK UP Champions—implicit and explicit racial bias education
  • Allies HMO
  • New guidelines
  • Reminder: ACCESS Law contraception coverage
  • Revised and new medical policies
  • My Care Family- new letter for EMR
  • CPT code updates
  • Drug code updates 

Read More

Providers in the know: February 2021 edition

Featured story:

COVID-19 vaccine updates

With the vaccine rollout underway, we’ve compiled some of the most common questions your patients are asking in an easy-to-read FAQ . We cover where and when patients can the vaccine along with eligibility, payment, efficacy, safety, and mask wearing post-vaccination.

Reference these questions and more on our Coronavirus Resource Center for patients, providers, and employers. We'll continue to update the information regularly. So check back frequently and share the link go.allwayshealthpartners.org/coronavirus with your patients. 

In this issue:

  • COVID-19 vaccine updates
  • Reminder
  • Inpatient PA waiver extension
  • Medical Policy Updates
  • HCPCS Code Updates

Read More

Join Us

Receive important administrative and regulatory updates that make it easier for your practice to do business with us. Updates once per month.

Archive