March 2019

Featured Story: Stay Connected with Us

AllWays Health Partners is committed to getting you the information and updates you need to easily do business with us. Sign up for our Provider Blog and follow us on Twitter.

In this Issue

• Stay Connected With Us
• Provider Directory Survey
• CareCentrix
• 2019 Fee Schedule Updates
• Medical Policy
• HEDIS Data Collection
• Contact Information

Stay Connected With Us

AllWays Health Partners is committed to getting you the information and updates you need to easily do business with us. By spending less time with administrative tasks, you can spend more time with what matters the most, your patients. The following are dedicated provider tools to help you and your staff to stay connected:

• Bookmark our webpage at allwaysprovidernetworks.org
• Register for the Provider Blog
• Follow us on Twitter

Provider Directory Survey

AllWays Health Partners is performing an annual assessment of the accuracy of data in our provider directory. Incorrect data contributes to patient dissatisfaction and can result in claims payment problems. In order to better support our members and providers, we ask that you verify that your provider directory entry is complete and correct.

To begin, please complete the Provider Directory Survey today. All completed surveys will be entered into a raffle drawing.

CareCentrix

2019 Fee Schedule Updates

On April 1, 2019, AllWays Health Partners will update the following:

• Standard professional fee schedules, incorporating recently released Medicare relative value units (RVUs) and laboratory rates for 2019
• Commercial Outpatient Fee Schedule, incorporating recently released Medicare OPPS codes, weights and rates
• Durable medical equipment (DME) fees, which may also include changes resulting from AllWays Health Partners' annual review of purchase (NU) and rental (RR) terms
• Drug and Vaccination fee schedule, with rates established in relation to CMS or
• Average Wholesale Price (AWP), if no CMS pricing is available
• Individual consideration pricing for unclassified drug codes, to better align with AllWays Health Partners' standard fee schedule pricing for injectable drugs

Medical Policy

The following medical policy updates are effective March 1, 2019:

• Mobile Cardiac Outpatient Therapy - Annual review without substantial changes in medically necessary indicators. Updated references.
• Outpatient Chest Physical Therapy - Annual review without substantial changes in medically necessary indicators.
• External Counterpulsation - Annual review without substantial changes in medically necessary indicators.
• Home Health Care - Off cycle review to update coverage. Home Asthma visits are no longer covered. Language removed

Click Here to view all medical policies.

HEDIS Data Collection

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely-used standardized set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to help consumers compare health plan performance to other plans and to national or regional benchmarks.

Each year, NCQA requires health plans to collect and report HEDIS data from contracted providers. HEDIS data collection will run from January 2019 through the end of May 2019. A member of AllWays Health Partners' HEDIS staff will ask you to fax, mail, submit by FTP the information or schedule an onsite review at your location.

Based on the HEDIS measures, PCPs and a subset of specialties such as OB/GYN, cardiology, ophthalmology, and optometry are the most likely to receive a medical records request.

We appreciate your cooperation and timely response during this review and thank you in
advance.

For more information, view the HEDIS FAQ.