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July 2020

Featured Story: New tools to simplify the prior authorization process

During this unprecedented time, we understand that it’s more important than ever for providers to spend less time on administrative work and more time on what matters most – your patients. To support this, AllWays Health Partners is launching several enhancements to our digital prior authorization tools and removing prior authorization requirements for certain services.

In This Issue

 


 

Coming soon: New tools to simplify the prior authorization process

During this unprecedented time, we understand that it’s more important than ever for providers to spend less time on administrative work and more time on what matters most – your patients. To support this, AllWays Health Partners is launching several enhancements to our digital prior authorization tools and removing prior authorization requirements for certain services.

We've created a webpage to highlight all the enhancements. The latest updates and resources will be added as they become available. 

Here’s a sneak peek at what’s coming.

Search authorization requirements by code

Later this summer, we’re launching a tool so you can search by code to see authorization requirements instantly. By having easy access to the latest requirements, this will reduce the number of unnecessary requests and save you time.

Immediate approval for medically necessary outpatient services

In September, we are enhancing the prior authorization functionality in our provider portal:

  • For outpatient services that meet criteria, you will receive approvals in seconds
  • Seamless process: request authorization and enter medical necessity information in one screen
  • Get approvals 24-hours a day, 7 days a week

These enhancements are designed to speed up the authorization process so you can discuss next steps with your patients before they even leave your office.

Removing prior authorization requirements

As part of the efforts to improve the provider experience, there will be several changes to the authorization requirements for services managed by eviCore effective July 1, 2020.

AllWays Health Partners will be lifting the prior authorization requirement across all lines of business for several services that are currently managed by eviCore. This includes:

  • Diagnostic heart catheterizations
  • Nuclear medicine
  • Radiation therapy
  • Diagnostic ultrasound
  • And more

Additionally, prior authorization will be managed by AllWays Health Partners for the following service. Please submit requests for this service through our secure provider portal:

  • A9513 - Lutetium Lu 177, dotatate, therapeutic, 1 mCi

For full list of changes, click here.

There are no changes to all other services managed by eviCore. These services will continue to require prior authorization. The list of services that will continue to require prior authorization through eviCore is available on eviCore’s webpage.

Stay connected

 If you are not registered for the Provider Portal, we encourage you to sign-up today at allwaysprovider.org. For support on Provider Portal registration, email us at prweb@allwayshealth.org.

We look forward to implementing these new tools as well as other enhancements to the provider experience. Over the next several months, stay tuned for more information and training opportunities. We will be sharing updates through our Provider Newsletter. Register today to get the latest updates.

 


 

COVID-19 updates

Remember to check our COVID-19 FAQs for providers

Our COVID-19 FAQs for providers give you the latest information, updates and resources. We are constantly updating these FAQs as more information becomes available from the Federal and State governments. Please check back periodically to get the most recent news.

Read the COVID-19 FAQ for Commercial providers

Read the COVID-19 FAQ for My Care Family providers

Access free virtual care app through AllWays on Teams

As a reminder, we've partnered with Microsoft to offer our network providers with free access to a virtual care app through AllWays on Teams. AllWays on Teams will be available to our providers through the COVID-19 pandemic and beyond - at no cost.

Learn more about AllWays on Teams and register to get access today 

AllWays on Teams FAQ

 


 

Formulary updates

AllWays Health Partners regularly reviews and updates our formulary to ensure alignment with the industry. Check out the latest updates effective September 2020. 

For the latest information on our pharmacy programs, visit our online formulary today.

 


 

Medical policy

The following medical policy updates are effective July 1, 2020:

  • Assisted Reproductive Services/Infertility Services - Annual review. Policy revised to include:
    • Revised Overview section; removed list of the preferred IVF brand medications
    • Revised Covered Services/Procedures to include Percutaneous epididymal sperm aspiration
    • General Eligibility Coverage Criteria updated;
      • Added azoospermia as a cause of unknown infertility
      • Under Anatomy section:
          • Added hystero-salpingo contrast sonography (HyCoSy)
          • Removed “carrying capacity must be demonstrated”
          • Revised language regarding hysteroscopy timeline to 2 years
    • Revised Individuals with a Sterilization Reversal section to clarify female reversal to include hystero-salpingo contrast sonography (HyCoSy)
  • Dental Treatment Setting - Annual review. Asterisk added to Table 1 MassHealth column and Exclusion 2. References updated.
  • Hearing Devices – Annual review. Codes updated. References updated. 
  • Hypoglossal Nerve Stimulation Implant for Obstructive Sleep Apnea – Annual review. References updated.
  • Speech Generating Device - Annual review. References updated.
  • Zolgensma - Added code (J3399)

View all medical policies.

 


 

Code updates

Stay current on the latest code and reimbursement updates.

Check out the latest updates here.

 


 

Provider payment guidelines

The following provider payment guideline has been updated: 

  • General Coding and Billing
  • Laboratory & Pathology
  • Skilled Nursing Facilities 
  • Inpatient Rehabilitation and Long-Term Acute Care (LTAC) 
  • Preventative Services

View all provider payment guidelines

 


 

Reminder: Confirm your Provider Directory information

To ensure that your patients and prospective patients have access to the correct information for your practice, it is important to regularly validate your practice information in our Provider Directory and let us know when an update is needed.

Remember to review information such as: contact information (telephone, fax, email), addresses, website information, network participation status, availability to see new patients, and which individual providers work at each practice location.

You can submit a provider information update request 24/7 through our secure Provider Portal or by submitting the Standardized Provider Information Change Form to pec@allwayshealth.org.

 


 

Hospital inpatient utilization report

The latest quarterly hospital inpatient utilization report is now available. To review this report, click on the Reports tab in the Provider Portal and select Clinical Reports. If you do not have access to the Provider Portal, you may register online at allwaysprovider.org.




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