Featured Story: Learn more about instant outpatient prior authorization approvals
Beginning October 26, 2020, you will have access to an enhanced prior authorization process that gives you immediate approvals for outpatient services that meet criteria. Register today for an upcoming webinar to get a sneak peek.
In This Issue
- Webinar: Learn more about instant approvals for outpatient prior authorizations
- Allies HMO is now available
- Provider Portal updates
- Survey: Is your Provider Directory information accurate?
- COVID-19 updates
- Medical policy
- Code updates
- Hospital inpatient utilization report
- Contact information
Webinar: Learn more about instant approvals for outpatient authorizations
Beginning October 26, 2020, you will have access to an enhanced prior authorization process that gives you immediate approvals for outpatient services that meet criteria.
We're offering webinars to give you a sneak peak and learn how to use the new tool:
- Wednesday, October 7, 12-1 PM
- Tuesday, October 13, 12-1 PM
- Tuesday, October 20, 11-12 PM
- Thursday, October 22, 2-3 PM
Allies HMO is now available
Allies, a brand new health plan product in partnership with Newton-Wellesley Hospital, is now available. Here are some important things you should know about Allies:
Allies offers unique features
Some of the features that Allies members have access to include:
- A dedicated health navigator - The Allies health navigator will support the member with getting set up with the plan, selectig their PCP, scheduling appointments and much more.
- Quicker appointment times for select specialties - members are guaranteed an appointment within 3 business days
- Enhanced virtual care - including a NEW virtual primary care group as well as $0 cost sharing for all virtual visits
Allies members have access to the Newton-Wellesley Hospital Community Plus network
Visit the Provider Directory to verify which practices are included in the Newton-Wellesley Hospital Community Plus network.
Providers who are not included in the Newton-Wellesley Hospital Community Plus network must obtain prior authorization for all services.
Check out the Allies member ID card
The front of the Allies member ID card indicates the product name ("Allies HMO") as well as the Newton-Wellesley Hospital Community Plus network that the member has access to.
Watch our Allies provider training to learn more.
Provider Portal updates
We are constantly looking for enhancements to ensure that you and your staff have an optimal experience through our Provider Portal. Here's a look at updates you'll see in October:
Billing Section
As we add new features, our goal is ensure that your resources are easy to access. As part of this goal, we are combining the claims status search, explanation of payment search and EFT/ERA enrollment into one section on the provider portal homepage. With this update, you'll continue to have access to the all the same functionality in a central location.
New requested service drop-down menu options
When submitting prior authorization, the following services will be options to select in the Requested Service drop-down:
Home Care
- Enteral Product and Home Infusion
- Home Health Aide ADL
- Nutrition Consultation
Outpatient
- DME Enteral Product
- Early Intervention ABA
- Experimental and/or Investigational
- Specialty Medication
Viewing unit/visit status
When viewing the units/visits on an authorization, the total and used number of units/visits are currently summed up on the initial service line. Example:
Coming soon, the total and used number of units/visits will remain with their corresponding requested service line. Example:
Please note that this is only a change in how the units/visits are displayed. The total and used number of units/visits will not be impacted.
Survey: Is your Provider directory information accurate?
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.
It is important that each one of our providers confirms basic information for us on a regular basis including but not limited to the following:
- Contact Information, Addresses and Website
- Network Participation Status
- Availability to See New Patients
- Group Practices
In order to better support our members and providers, we ask that you verify that your provider directory entry is complete and correct. Please take a few minutes to complete our Provider Directory Survey.
COVID-19 updates
Reminder: Check our COVID-19 FAQs for the latest updates
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
Medical policy
The following medical policy updates are effective October 1, 2020:
- Absorbent Products for Incontinence - Added fecal incontinence as covered criteria. Removed fecal incontinence exclusion. References updated.
- Bariatric Surgery – Annual review. References updated.
- Outpatient Drug Screening and Testing - Annual review. References updated.
- Zolgensma - Annual review. References updated.
The following medical policy updates are effective December 1, 2020:
- Breast Surgeries - Off-cycle review. Updated Table on Page 1. Revised Coverage Guidelines criteria to create separate subheadings and criteria for Reconstructive Surgery, Breast Reconstruction Related to Breast Cancer Treatment, Breast Reconstruction Related to Gender Affirming Procedures, and Breast Reconstruction Related to Other Medical Conditions. Under Exclusions, revised "Mastopexy for breast reconstruction unless it is for cancer related mastectomy/lumpectomy" to state "Mastopexy for breast reconstruction unless it is for cancer-related mastectomy/lumpectomy or severe deformity due to Poland's Syndrome or Breast Trauma". Under Definitions section, removed definition of Cup Size.
- Enteral Nutrition Formulas and Supplements - Annual review. Revised risk factor criteria on page 2 to include reference to Table A. Removed "documented soy formula intolerance". Changes to exclusions 7 and 8 for clarity. Added Table A. References updated.
Code updates
Stay current on the latest code and reimbursement updates.
Check out the latest updates here.
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.