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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.

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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)

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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.
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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)


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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

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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.

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

In this issue:

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Topics: Providers

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