Pay BillSCOPE | Provider Update
October 2023
Clinical Matters
October is Breast Cancer Awareness Month - the importance of screening
October is Breast Cancer Awareness Month. Continued community efforts aim to promote screening and prevention of the disease, and updated screening recommendations are coming.
In the U.S., breast cancer is the most diagnosed cancer and the second-leading cause of cancer death among women. The disease affects one in eight women in the U.S. every year and 2.3 million women worldwide. A man’s risk is much lower, and 1 in 833 men will get breast cancer in his lifetime. In 2023, an estimated 297,790 new cases of breast cancer are expected to be diagnosed and 43,250 women will die from the disease.
Breast Cancer Awareness Month is an excellent time to remind patients about the importance of breast cancer screening. Regular breast cancer screening saves lives. According to the American College of Radiology, mammography has helped reduce breast cancer mortality in the U.S. by nearly 40% since 1990. One study shows mammography screening decreases the risk of breast cancer death by just under half. Three out of four women diagnosed with breast cancer have no family history of the disease and are not considered high-risk.
Screening Recommendations; new USPSTF guidelines coming
Breast Cancer Screening recommendations come from a variety of sources. Currently, the United States Preventive Services Task Force (USPSTF) breast cancer screening guidelines are being updated. The current USPSTF guidelines recommend women ages 50 to 74 years to screen every two years, and individual screening decision making for women ages 40 to 49 years. The pending update is expected to reflect that the Task Force’s draft recommendation that all women at average risk of breast cancer get screening every other year starting at age 40. This change brings greater consistency with the American Cancer Society’s (ACS) screening recommendations for women at average breast cancer risk.
ACS screening recommendations include optional screening beginning at age 40 years. Of note, those at increased risk of breast cancer may require screening approaches tailored to specific circumstances.
Risk Factors
The risk of breast cancer varies, based on a variety of factors including age, genetics, race and ethnicity, and lifestyle. Epidemiologic research indicates that incidence of breast cancer increases with age, until patients reach the decade of seventy, when risk typically begins to decline.
Patients are at a higher risk of developing breast cancer if they have close relatives who have been diagnosed with the disease, especially immediate family relatives such as mothers, sisters, or daughters.
The risk increases if patients have multiple close relatives with breast cancer. Breast cancer incidence and death rates vary by race and ethnicity. Incidence rates are highest among White women, followed by Black women, then America Indian/Alaska Native, Asian/Pacific Islander, and Hispanic women. Mortality rates among Black women are higher than among women of any other race or ethnic group; this could be in part to one in five Black women are diagnosed with triple-negative breast cancer.1 Triple-negative breast cancer is more aggressive than other types of breast cancer.
Living a healthy lifestyle, incorporating sustainable nutrition and regular exercise, among other things, can help to decrease one’s risk of breast cancer. Provider recommendations are important for patient adherence, not only healthy lifestyle, but also for cancer screening. Having discussions with patients about the risk factors for breast cancer, and the benefits of breast cancer screening can really make a difference.
Based on your patients’ benefit plans, they may qualify for a reward for completion of breast cancer screening. Members may be eligible to earn an incentive for completing a mammogram based on their benefit plan:
- Medicare members can earn $20 in rewards toward their NationsOTC® account for getting a mammogram.
- Commercial insured and self-funded members can earn $10 for getting screened for breast cancer. RedShirt Rewards allows members to earn up to $30 each plan year in the form of gift cards to popular retailers.
If you participate in Independent Health's Primary Value Program, or the Medicaid Provider Incentive Program, you are eligible for incentives related to closing breast cancer screening gaps in care.
- 2023 Primary Value Program: Primary Care is a value-based reimbursement program that began in 2018. This program rewards primary care providers for supporting value by focusing on quality measures and closing gaps in care, across the Commercial, Medicare, and Medicaid lines of business.
- 2023 Medicaid Provider Incentive Program: This quality incentive program is designed to improve the overall quality of care for Independent Health’s MediSource, MediSource Connect and Child Health Plus members by providing incentives to primary care physicians to support increased delivery of recommended care for patients attributed to their practice. For additional information, click here: 2023 Medicaid Provider Incentive Program Guide.
If you would like to learn more about participating in the programs mentioned above, or have any questions, please contact Independent Health’s Provider Relations department by phone at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m. or reach out by email at Engagement@independenthealth.com
Strategies to decrease HIV infection rates: Testing, PrEP
HIV remains a significant public health concern. By incorporating two tactics, PCP practices can help decrease the infection rate of HIV. In addition, the USPSTF released new PrEP guidelines.
HIV continues to be a significant public health concern in the United States, with approximately 1.2 million people currently living with the virus. The actual number of people living with HIV is likely much higher. In 2020 alone there were more than 30,000 new diagnoses. It is estimated that roughly one in seven people are unaware of their diagnosis because they’ve never been offered HIV testing.
Primary care clinicians can help decrease rates of HIV infection by adopting two practices:
- Offer testing to all patients over 13.
- Prescribe pre-exposure prophylaxis (PrEP) to people who are sexually active.
Pre-exposure prophylaxis is an antiretroviral medication that reduces the risk of contracting HIV through sex by 99% when taken as prescribed, according to the Centers for Disease Control and Prevention (CDC). Many people who would benefit from PrEP, including those who are significantly more likely to be diagnosed with HIV, don’t receive this highly effective medication. This is particularly true for Black, Hispanic, and Latino people.
The US Preventive Services Task Force (USPSTF) published new PrEP guidelines in August 2023. The guidelines call for clinicians to educate all patients on HIV testing strategies, and PrEP as an option for HIV prevention. They also recommend prescribing PrEP to adolescents and adults who do not have HIV but are at an increased risk for infection.
Primary care physicians are ideally positioned to prescribe PrEP for their patients because they have longitudinal relationships: they get to know their patients, and hopefully their patients feel comfortable talking with them about their sexual health.
Clinicians should consider PrEP for all patients who have sex with someone who has HIV, do not use condoms, or have had a sexually transmitted infection within the previous 6 months. Men who have sex with men, transgender women who have sex with men, people who inject illicit drugs or engage in transactional sex, and Black, Hispanic, and Latino individuals also are at increased risk for the infection. Heterosexual patients at high risk, or anyone who asks about PrEP, regardless of their reasoning, should also be offered PrEP.
Three similarly effective forms of PrEP approved by the US Food and Drug Administration (FDA) enable clinicians to tailor the medications to the specific needs and preferences of each patient:
- Truvada (emtricitabine and tenofovir disoproxil fumarate) and Descovy (emtricitabine and tenofovir alafenamide) are both daily tablets.
- Descovy is not advised for people assigned female sex at birth who have receptive vaginal sex.
- Apretude (cabotegravir), an injectable agent, is not recommended for people who inject illegal drugs. These medications are covered on the NYS Medicaid formulary.
The medications are very well-tolerated, particularly if people expect some short-term side effects, including headache, gas, and upset stomach. Most patients on PrEP have no problems; they have regular lab work and can follow up in person or by telemedicine.
For more information about PrEP and how to utilize these powerful medicines to prevent HIV transmission, please visit the HIV Provider Toolkit on the Independent Health Provider Portal. For further questions please contact Joshua Sawyer, PharmD, AAHIVP at 716-250-4478 Monday through Friday between the hours of 8 a.m. and 3 p.m.
Low back pain study finds opioids unnecessary
Study published in Lancet suggest opioids prescribed for low back & neck pain may lead to worse outcomes
The July 22, 2023 edition of the Lancet journal published results of the first randomized controlled trial testing the efficacy and safety of a short course of opioids for acute nonspecific low back/neck pain. The results suggest opioids do not relieve this pain in the short term and lead to worse outcomes in the long term.
After six weeks, the trial found no significant difference in pain scores, or in functional improvement, of patients who took opioids compared to those who took placebo. After one year, patients given the placebo had slightly lower pain scores.
Another important finding: the risk of opioid misuse at one year doubled among patients randomly allocated to receive opioid therapy for six weeks compared with those allocated to receive placebo for six weeks.
Before this trial, there was no good evidence on whether opioids were effective for acute low back or neck pain, yet opioids were one of the most used medicines for these conditions. As many as two-thirds of patients will receive an opioid when presenting for care of back or neck pain.
The results of this trial suggest that most people with acute low back pain and neck pain recover well with time (usually by six weeks), so management is simple ― staying active, avoiding bed rest, and, if necessary, using a heat pack for short term pain relief. If drugs are required, consider anti-inflammatory drugs, such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDS). There is no evidence that opioids should be prescribed for people with acute non-specific low back or neck pain.
Pediatric Matters
Optimizing childhood development through early intervention initiatives
Efforts are underway to increase crucial screening rates among newborns and toddlers.
Early identification of developmental disorders is crucial to the well-being of children and their families1. However, many children are not identified as having developmental delay until school entry – beyond the timeframe for Early Intervention services2. Studies indicate that less than one-third of all children aged 9 to 35 months of age have received a standardized parent-completed developmental screening tool from a healthcare provider in the last year3.
The NYS Department of Health was working with Medicaid Managed Care Plans on a Performance Improvement Project known as KIDS PIP. In KIDS PIP, Medicaid Managed Care Plans are partnering with primary care to:
- promote timely global developmental screening;
- improve statewide screening rates for children 0-3 years of age;
- improve early intervention and early childhood services referral rates for children who have positive developmental screening.
The American Academy of Pediatrics (AAP) recommends the periodic administration of standardized multi-domain screening tool at well child visits at ages 9 months, 18 months and 24 (or 30) months with developmental surveillance at all other well child visits. In addition, the AAP also recommends screening with an autism-specific screening tool during 18- and 24-month visits.
Resources are available to support practices and their families with young children.
References:
[1] American Academy of Pediatrics – Policy Statement _ Identifying Infants and Young Children with Developmental disorders in the Medical Home: An Algorithm form Developmental Surveillance and Screening. Pediatrics Vol 118 (1). July 2006
[2] Lifecourse Health Development. Past, Present and Future. Halfon. N., et al. Maternal and Child Health Journal. 2014 Vol18(2): 344 2015
[3] Prevalence and Variation of Developmental Screening and Surveillance
Early identification of hearing loss in children is a focus of NYS Performance Improvement Plan
Early detection of hearing loss can diminish the impact on language and speech acquisition, academic achievement, and milestone development.
Early identification of hearing loss is crucial to the well-being of children and their families1. Children who are diagnosed as deaf or hard of hearing face a potential developmental emergency and should be identified as soon as possible for appropriate intervention. If detected early, the negative impacts of hearing loss on language and speech acquisition, academic achievement and milestone development can be diminished thorough timely early intervention2.
According to the CDC, while over 98% of U.S. newborns were screened for hearing loss in 2019, some infants needing additional testing or early intervention did not receive these important follow-up services. About 6,000 infants born in 2019 were identified with permanent hearing loss and the prevalence of hearing loss was 1.7 per 1,000 babies screening3.
The NYS Department of Health formerly worked with Medicaid Managed Care Plans on a Performance Improvement Project known as KIDS PIP. Although the KIDS PIP has ended, Independent Health has chosen to continue to focus our efforts on Newborn Hearing Screening. Independent Health’s Medicaid Managed Care Plan is partnering with primary care and the New York State Early Hearing Detection and Information program to emphasize a ‘1-3-6’ plan:
- Before 1 month of age: hearing screening
- Before 3 months of age: hearing evaluation
- Before 6 months of age: early intervention
The American Academy of Pediatrics (AAP) recommends screening using the I-3-6 algorithm guidelines for Pediatric Medical home Providers4. AAP goals include ensuring that every child diagnosed with hearing loss receives timely, appropriate intervention, to enhance knowledge of the 1-3-6 algorithm and ensure that EHDI is integrated in a medical home approach to child health5. Medical homes play a key role in educating families about the hearing screening results and supporting families in re-screening, follow up testing and monitoring.
Independent Health is committed to supporting our pediatric and family practice providers remain informed and updated on Newborn Hearing Screening resources posted on the Quality page under Resources in our secure provider portal.
We created a resource guide to help inform your office about relevant guidelines, identify workflows to ensure timely testing and follow up, and other important information. If you have questions about the initiatives, performance reports or about anything else related to the Newborn Hearing Screening, Contact your Independent Health Physician Engagement Specialist.
References:
[1] American Academy of Pediatrics – Policy Statement _ Identifying Infants and Young Children with Developmental disorders in the Medical Home: An Algorithm form Developmental Surveillance and Screening. Pediatrics Vol 118 (1). July 2006
[2] National Center for Hearing Assessment and Management. NCHAM. Accessed at https://www.infanthearing.org/newborn-hearing-screening/nhsresources.html
[3] Newborn Hearing Screening, Diagnosis, and Intervention. Accessed at https://www.cdc.gov/ncbddd/hearingloss/data.html
[4] American Academy of Pediatrics – Early Hearing Detection and Intervention testing algorithm accessed at https://www.aap.org/en/patient-care/early-hearing-detection-and-intervention/
NYSDOH Performance Improvement Plan targets lead poisoning prevention
Lead poisoning is preventable through regular lead screening and management
Initially, to positively impact a healthy development trajectory for children during the first years of their life, the New York State Department of Health ‘s Performance Improvement Project (PIP) for Early Childhood lead poisoning prevention Childhood Development for NY Medicaid Managed Care Organizations was initiated in 2019 and was extended until the end of 2021. The aim of the Early Childhood Development PIP was to identify and lower the risk for delayed or disordered development through three focus areas, including Lead Testing and Follow up. Although the PIP ended, lead poisoning prevention remains an area of focus for Independent Health’s External Quality Review.
There is no safe level of lead in the body
We know that children are especially susceptible to harm from lead exposure. Children under six years of age are at greatest risk because their brains are growing rapidly, and their bodies absorb lead at a higher rate than adults. Lead poisoning among children can cause developmental delays, learning difficulties, vomiting, abdominal pain, hearing loss and seizures. It is well documented children in low-income families are more likely to live in older housing with lead paint and are at risk for lead exposure and in turn, higher lead levels. There is evidence that lead is passed from mother to baby in utero, the occurrence of which may be more likely among underserved patients, depending on circumstances.
The good news is that lead poisoning is preventable through proactive lead screening, confirmatory testing, and further management as indicated. Independent Health has continued our efforts beyond the Process Improvement Program to increase lead screening rates and link to treatment those children under age five found to have elevated blood lead levels (BLLs). This program aligns with the CDC guidelines. While the quality improvement program was in process, we saw positive change from the attention and extra efforts put forth by our member practices.
Although screening rates are improving, there are still opportunities to improve follow-up testing, with rates of confirmatory tests and treatment appearing quite low. Children are being screened, but there are apparent opportunities to improve follow-up processes. Once children are identified as having high lead levels (NYS rates of 5 mcg/dL as the benchmark), a follow-up plan including confirmatory testing, is recommended. We appreciate the efforts and partnership of our Pediatric providers in furthering lead poisoning prevention. We still have work to do, but continued diligence and adherence to appropriate screening timelines and guidance will continue to improve these trends. For more information on childhood lead poisoning prevention, visit the healthcare resources section on the CDC website: Childhood Lead Poisoning Prevention Program | CDC
Office Matters
Final date to submit gaps-in-care corrections: Jan. 3, 2024
Make sure to get your gaps-in-care corrections into Independent Health if you find inaccuracies for certain reasons.
The last day to submit 2023 gap-in-care corrections for medical record documentation to Independent Health through our provider portal is Wednesday, January 3, 2024 at 6 p.m.
After this date, we will no longer accept gap-in-care corrections for the 2023 calendar year.
We will inform participating providers when we will begin accepting gap-in-care corrections for 2024.
The Gaps in Care Correction process allows for medical record documentation to be submitted to “correct” inaccuracies in quality measure results due to a variety of reasons, including:
- Encounters or lab values not available to the health plan
- Exclusions from a historical event (e.g., mastectomy)
- Service that was rendered under a different payer
If the correction is accepted, it will be reflected in an update to your quality rates (and Independent Health's), which allows for:
- A more accurate depiction of the quality of care that was rendered
- More accurate quality program reporting
- More targeted quality improvement effort
View the Gaps in Care Correction Process User Guide, view a webinar and learn more about submitting correction requests in our secure provider portal. (This information is in the Quality section under the Resources tab selection.)
If you have questions about the gaps in care correction process, performance reports or anything related to our provider portal:
Contact your Independent Health Physician Engagement Specialist or Email ProviderPortal@independenthealth.com
Survey Results - NYS standards for appointment access and availability
Results of a telephone survey with participating practices to gauge their compliance with New York State's access and availability standards are in.
To ensure compliance with standards established by New York State for our participating providers, Independent Health partnered with an outside vendor, SPH Analytics, to conduct brief surveys by phone regarding appointment access and availability for our members. This survey was directed to specific types of providers, including Primary Care Physicians, Medical Oncologists, Ob/Gyns, Psychiatrists, and Psychologists.
The primary objectives of this survey are:
- To comply with state regulations set forth in Independent Health’s contract with the state of New York.
- To provide quantifiable feedback to Independent Health regarding physician compliance with the access and availability.
- To help Independent Health improve the services provided to its members.
All scenarios presented are based on the following types of care:
- Emergent
- Urgent
- Sick visits (routine non-urgent/emergent)
- Initial and Follow-up Routine, non-urgent or preventative care
- Adult baseline and routine physicals
- Non-life-threatening emergency care
- Prenatal Trimester Care
- Hospital Discharge Follow-up treatment
2023 Summary of Results:
The Appointment Availability and After-Hours Surveys were administered April 21 – June 5, 2023. The overall compliance is 69% among all providers for the Appointment Availability and 90% for After-Hours. Any office that was found out of compliance will be notified by Independent Health and sent an action plan that requires a plan of correction. We would like to thank all the providers who participated in the survey.
Overall Compliance
|
|
Number of Providers |
Number Fully Compliant |
Number Non-compliant |
Percent Fully Compliant |
|---|---|---|---|---|
Total completed surveys |
771 |
529 |
242 |
69% |
PCPs |
328 |
254 |
74 |
77% |
OB/GYNs |
122 |
102 |
20 |
84% |
Medical Oncologists |
82 |
82 |
0 |
100% |
Behavioral Health Prescribers |
7 |
2 |
5 |
29% |
Behavioral Health Non-Prescribers |
197 |
83 |
114 |
42% |
Behavioral Health Mental Health Facility |
35 |
6 |
29 |
17% |
After Hours - Overall Compliance
Total Providers Surveyed |
Number Fully Compliant |
Number Non-Compliant |
Percent Fully Compliant |
|---|---|---|---|
313 |
283 |
30 |
90% |
If you have questions, please contact our Provider Relations Department by calling (716) 631-3282 or 1-800-736-5771, or via email at providerservice@servicing.independenthealth.com, Monday through Friday from 8 a.m. to 6 p.m.
Coding tips for complete and accurate patient risk scores
Accurate and complete coding improves ability to identify patients for disease & case management.
It is important to ensure that all diagnoses reported on a claim are complete and accurate when submitted for payment. This will not only improve office efficiency and ensure proper payment the first time, but will also improve the ability to identify patients for disease and case management. Always report current and active conditions on a claim at least once per year.
Diagnosis specificity
All claims must include valid ICD-10-CM diagnosis codes fully justified to the highest degree of specificity to identify the member's medical conditions.
For conditions that have a direct relationship with Diabetes, dual coding is required when chronic conditions exist. When co-morbidities and/or complications are manifestations of diabetes mellitus and are medically managed during the office visit, the ICD-9-CM diagnosis codes billed must reflect the correct combination code from the diabetes section of the ICD-9-CM code book.
Coding Example #1: Uncontrolled diabetes with stage 3A CKD
- Correct coding: E11.22, N18.31
- Incorrect coding: E11.9
Coding Example #2: Chronic Diastolic Heart Failure
- Correct coding: I50.32 (important to designate acute/chronic, systolic/diastolic)
- Incorrect coding: I50.9
Claims that are not coded to the highest degree of specificity may be selected for chart review to ensure accuracy.
Coding Acute Conditions
It is important that acute conditions are coding in compliance with ICD-10-CM coding guidelines. Significant acute conditions are often coded in the acute phase when they should actually be coded as a past history.
Cerebrovascular Accident / Infarction /Transient Ischemic Attack (I63.xx/G45.x)
Only code for active TIA or CVA when in the acute phase or initial encounter. A sequela is the residual effect after the acute phase of an illness or injury has terminated. The code for the acute phase is never used with a code for the residual effect.
Pulmonary Embolism/Deep Vein Thrombosis (I26.xx/I82.xx)
It is important to determine acute vs chronic PE or DVT. An acute DVT is a new thrombosis that requires initiation of anticoagulant therapy. A chronic DVT is an old or previously diagnosed thrombus that requires continuation of therapy. Therapy may also be prescribed for prophylactic purposes to prevent recurrence. In this instance do not code the DVT.
Malignant Neoplasms
The active malignancy code should be used until treatment is completed. When there is no further treatment and no evidence of any existing primary malignancy, use the personal history of malignant neoplasm code.
Inactive provider portal accounts to be terminated
Portal accounts will be terminated if inactive since 2022.
To maintain the security of Independent Health’s provider portal, we will terminate portal accounts that have been inactive since January, 2022. We will terminate the accounts on Friday, November 3, 2023.
If any of your accounts need to be reactivated, please contact Provider Relations.
We also encourage portal administrators to regularly review their overall account access and determine which users still need access and which users’ accounts you should terminate due to inactivity, change in responsibility or termination of employment.
Coming later this year: New Member ID Numbers
Self-funded and commercial members will be assigned new ID numbers that begin with W.
Recently Independent Health announced that we will offer an expanded, comprehensive national network for our commercial and self-funded lines of business this fall.
The enhanced national network will cover members who live outside of Independent Health’s traditional Western New York service area, while serving as the travel network for members who live locally.
To accommodate the national network, all Independent Health commercial and self-funded members will receive new ID cards with new ID numbers upon their plans’ renewal dates. The new ID numbers will begin with “W.” (The ID numbers for Medicare and State program members will not change).
It is important to ask patients if they have new ID cards and to use their new Member ID numbers. However, this should have no effect on your billing, as the new ID number will track to the member’s current ID number.
Timing:
- A limited number of self-funded members will get their ID cards before December 1.
- Starting in December, commercial group members with a January 1 renewal date will begin receiving their new ID cards in December. Members may begin using their new ID cards as soon as they receive them.
Upcoming member campaigns to encourage our members to take greater control of their health
Throughout the year, the Health Care Services and Population Health Management Departments deploy various tactics to encourage members to take a more active role in their health.
During the month of October, Independent Health will be conducting the following member engagement/outreach campaigns:
Colorectal Cancer Screening Reminder
This telephonic outreach campaign will engage members who are overdue for a colorectal cancer screening. The purpose of the call is to provide education around the importance of colon cancer screening, address member barriers to screening, and encourage the member to follow through on screening orders received from their provider. Members who do not have an order for a colon cancer screening test will be encouraged to have a conversation with their provider regarding screening.
- Outreach method: Outbound telephone call campaign
- Target members: Medicare and Medicaid members who are overdue for a colorectal cancer screening
- Timeframe: October 2023
Breast Cancer Screening Reminder Campaign
This campaign will target women ages 50 to 74 within the Medicaid line of business who are overdue for a mammogram. The goal of this telephonic outreach campaign is to maximize mammography participation. Education around the benefits of receiving a mammogram, as well as information regarding how to address any barriers, and how to follow through with their provider’s orders will be discussed. Members who do not have an order for a mammogram will be encouraged to have a conversation with their provider.
- Outreach method: Outbound telephone call campaign
- Target members: Women aged 50 to 74 who are overdue for a mammogram- Medicaid members only
- Timeframe: October 2023
Asthma Action Plan
Starting in September, Independent Health will send eblasts to members regarding asthma and asthma management. The three eblasts include:
- Asthma Action Plans
- Coordinating Your Child’s Care between the school nurse and children’s providers to better manage triggers, symptoms, and rescue therapy during school hours.
- Trigger Identification and Management
These eblasts have three objectives:
- Patient self-advocacy and self-management strategies for their asthma, including trigger identification and management
- Helping patients understand the roles of controller and rescue medications and when to use them to improve asthma outcomes
- Optimizing the care relationship between school nurses and primary care providers for school age children
Target members: Members age 18 to 64 with a diagnosis of asthma; E-mail #2 is targeted to the guardians of members aged 5 to 18 with a diagnosis of asthma.
Timeframe: one informational eblast from this series will go out each month from August through October.
Diabetes Prevention Program Education Campaign
This email campaign will provide commercial members with prediabetes education around the benefits of enrolling in a Diabetes Prevention Program.
- Outreach method: Email
- Target members: Commercial members with prediabetes
- Timeframe: October 2023
Independent Health 2023 required compliance training and attestations coming due
Have you and your staff completed the required Fraud, Wast & Abuse and Cultural Competency Training? If not, here's how...
With three months left in the year, it is time for our participating providers to complete their annual required training if they haven’t done so already.
Independent Health is required by state and federal agencies to ensure our participating providers complete this annual compliance training. Once again, participating practices have to attest to completing each of the following by December 31, 2023:
Cultural Competency
All providers who treat Independent Health’s commercial and state program must attest annually that they have completed cultural competency training for all staff who have regular and substantial contact with Independent Health members.
To satisfy this training requirement, staff must complete the U.S. Department of Health & Human Services online module, “The Guide to Providing Effective Communication and Language Assistance Services,” or the comparable Think Cultural Health training that corresponds with the provider’s scope of practice, and submit the electronic attestation to confirm completion.
This cultural competency training and attestation is available online.
Fraud, Waste & Abuse Training
Independent Health requires each of its participating provider groups or practices to complete Fraud, Waste & Abuse Training and submit an electronic attestation to confirm completion of this training by each of their staff members.
Staff members of practices required to complete this training includes physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.
If your practice has already completed the 2023 Fraud, Waste & Abuse training and attestation through Independent Health, it is not necessary to attest to doing so again.
All related details, the downloadable training modules for your staff, and an attestation to verify with Independent Health that this training has been completed are available online.
Who must submit each attestation?
Each of the above attestations should be submitted by an authorized representative on behalf of all individuals under a practice’s Tax Identification Number (TIN). Therefore, each individual staff member who completes each training does not need to submit the attestation.
If your practice has already completed this 2023 training through another source and has a roster or spreadsheet with the dates the training was completed, you may submit the attestation through each of Independent Health’s public provider portal pages above.
Questions?
If you have questions, please call Independent Health Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.
Pharmacy Updates
Formulary and Policy Changes
The following documents are available in PDF. We encourage you to open and download them, as they contain important information and updates:
As announced in the September edition of Scope:
- Summary of policy changes for the Third Quarter of 2023
- Summary of formulary changes for the Third Quarter of 2023
View the most up to date versions of Independent Health’s policies when logged in to our provider portal
Magellan Rx, administered by Magellan Rx Management, reviews select specialty drug prior authorization requests on Independent Health’s behalf. View Magellan Rx policies for the drugs that they review.
Independent Health's drug formulary
Access Independent Health's drug formulary.
To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.
In the News
Independent Health in the News
Fitness in the Parks fosters friendships, healthy habits, Healthy Vision blog, Aug. 16, 2023
How to step up your walking routine, Healthy Vision blog, Aug. 1, 2023
Spotlight
Top Takeaways this Month
View October 2023 Policy Updates
Primary Care Physicians: Free CME-eligible webinar Oct. 18: James Behr, M.D., of Excelsior Orthopedics will discuss his approach to evaluating back and neck pain, common conditions affecting the spine, and the non-surgical treatment of these conditions.
Mark your calendars: PrEP Week 2023: Oct. 24 - 31.
Updated Provider Manual: We have updated the Provider Manual. It's posted in the secure portal.
Update your Digital Contact Information: Federal & State regulations require practices to provide specific information. View regulations Learn more here.