Featured Story: Learn more about Allies
Please join us on Tuesday September 22, 12-1 PM, to hear more about Allies, a brand-new health plan product in partnership with Newton-Wellesley Hospital that'll be available beginning October 1, 2020. Register today.
In This Issue
- Webinar: Learn more about Allies
- Update: New tools to simplify the prior authorization process
- COVID-19 updates
- High-tech radiology prior authorizations
- Formulary updates
- Medical policy
- Code updates
- AllWays Health Partners' drug fee schedules to be updated
- Reminder: Confirm your provider directory information
- Contact information
Webinar: Learn more about Allies
Please join us on Tuesday September 22, 12-1 PM, to hear more about Allies, a brand-new health plan product in partnership with Newton-Wellesley Hospital that'll be available beginning October 1, 2020.
In this webinar, you'll learn:
- How this product offers a new health experience
- What unique features ensure integrated, personalized, easy-to-access care- like Health Navigators and expanded virtual visit options, among others
- About our high-performance Newton-Wellesley Hospital Community Plus network, available only to Allies members, and how it’s different from our standard network
- How to identify an Allies member through our provider portal and member ID card
Update: New tools to simplify the prior authorization process
Earlier this year, we announced some exciting new tools coming soon to support you and your staff with the prior authorization process. Here are the latest updates.
Search authorization requirements by code
A new tool will soon be available that gives you easy access to determine authorization requirements by code.
In the first release, you'll be able to use this tool to search through our standard prior authorization requirements.
Immediate approval for medically necessary outpatient services
Coming soon, 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.
Stay tuned to learn more about this enhancement, when you should expect to see this tool in the provider portal, and upcoming training opportunities.
Resuming elective procedures and seeking necessary care
In a recent article in our Best Practice Provider Blog, we explored the impact that COVID-19 had on elective services as well as discussed the importance of receiving necessary care.
Check out our blog today and don't forget to register.
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.
High-tech radiology prior authorizations
We are dedicated to finding ways to improve your experience with eviCore, our utilization management partner for high-tech radiology, select cardiac imaging & diagnostic services, and molecular & genetic testing. For example, we recently lifted the authorization requirement for many services effective 7/1/20.
Avoiding unnecessary high-tech radiology denials
We know that its important to get timely approvals to ensure that you can schedule your patients service sooner. One of the top reasons for delayed approvals is that the appropriate clinical information is not provided when the request is made. When this happens, the authorization may unnecessarily be denied – and then eventually gets overturned through the appeals process.
To avoid unnecessary denials and appeals, its important to review eviCore’s clinical criteria for radiology services. These guidelines are designed to help you identify what information is needed to get an approval. Based on the criteria for the service you are requesting, its important to submit supporting clinical documentation that addresses
Click Here to access eviCore’s radiology clinical criteria for AllWays Health Partners.
To search through all of eviCore’s clinical guidelines:
• Visit https://www.evicore.com/provider/clinical-guidelines
• Choose the Program
• Choose the Health Plan (i.e. “AllWays Health Partners”)
• The applicable guidelines will populate
For important information and resources, visit eviCore’s page for AllWays Health Partners providers. On this site, you can access the clinical guidelines, a list of services that require prior authorization, quick references guides and more.
For support with submitting high-tech radiology authorizations, contact eviCore at 888-693-3211. For general inquiries, contact AllWays Health Partners at 855-444-4647. We are available Monday-Friday, 8:30 AM to 5:00 PM.
The following medical policy updates are effective September 1, 2020:
- Non-Emergent Medically Necessary Transportation - Coverage guidelines edited for clarity regarding participating providers. References updated.
- Specialty Medication - Site of Care – Off-cycle review. Overview section revised for clarity with language added "versus a less intensive site of care, such as in home." Language added regarding age requirement. Guidelines section updated to remove statement regarding "two dosage authorization in hospital" with language regarding grace period allowance. Criteria section changed to reflect new adverse event requirements found in sections 1a, 1b, and 1c. Removed sentence "The member's home has been determined to be inappropriate for home infusion by a social worker, case manager, or previous home nurse assessment." Subheading edited to "Criteria for Home Infusion Therapy."
Stay current on the latest code and reimbursement updates.
AllWays Health Partners’ drug fee schedules to be updated
AllWays Health Partners reviews its drug fee schedules quarterly to ensure that they are current, comprehensive and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes, to supplement the fees already on the fee schedule.
The next update will occur on October 1, 2020. Changes may involve both new and existing CPT and HCPCS codes, and will include the planned quarterly update to physician administered drugs, immune globulin, vaccine and toxoid fees.
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.