September 2024

We are preparing to add a layer of security to the provider portal by requiring multifactor authentication (MFA).  This security measure will be implemented by the end of this year. 

You may be familiar with two-factor or multifactor authentication.  Once MFA is in place, it will add a step to the log-in process by requiring portal users to confirm their identities by using a combination of two different factors:  by the user’s password, and by sending a code to the user’s email address or phone. 

Two-factor authentication makes it harder for attackers to gain access to a person's devices or online accounts, because knowing the victim's password alone is not enough to pass the authentication check.

Independent Health continues to monitor the effect of the Change Healthcare cybersecurity event on some providers’ ability to submit claims to Independent Health.

Independent Health has been extending timely filing through the end of May, June and July.  Due to ongoing issues, we will once again extend the timely filing relaxation period through September 30, 2024.

During this extension period, Independent Health will treat submissions for dates of service on and after the dates below as timely filed claims:

• Medicare and State Products = November 23, 2023
• Commercial Products = October 24, 2023

The approach remains the same: capture the earliest possible date of service for a still-timely claim as of February 21, 2024, which was the date the Change Healthcare cyber event occurred.

Independent Health may end the extension period earlier if billing is fully restored; additionally, we will consider continuing the timely filing extension period if the disruption continues beyond September 30, 2024.

Self-funded line of business:

Timely filing requirements for our self-funded line of business vary, and requests for reconsideration of untimely claims for self-funded clients will be reviewed on a group-specific basis.

If you have any questions or concerns, please contact Provider Relations Monday through Friday from 8 p.m. to 6 p.m. at 716-631-3292.

State Member Incentive Program Campaigns

Independent Health launched three member incentive programs for State members that will run through December 31, 2024.  Members received information regarding these incentive opportunities via letter and email in August 2024.

1. Gaps-in-Care Program - State members can earn gift cards for completing various preventive care tests and screenings included in the program.
2. Non-Utilizer Program - State members with 7 or more months of continuous enrollment without a claim on file are eligible to earn a gift card for completing an annual well visit.
3. Maternity Management Program - State members can earn gift cards for completing a prenatal visit during the first 12 weeks of pregnancy and postpartum visit within 11 weeks after delivery.

• Timeframe: August through December 31, 2024

Metabolic Monitoring for Children and Adolescents on Antipsychotics

The Independent Health Behavioral Health and Pediatric Case Management departments will outreach to parents or guardians of members under the age of 13 who have been prescribed an antipsychotic medication but have not received metabolic monitoring (glucose and cholesterol testing).  The Case Manager will provide the parent/guardian with education on the importance of metabolic screening for the child and encourage follow-up conversation with the provider regarding testing.

• Outreach method: Outbound telephone call campaign
• Target members: Commercial and Medicaid members under the age of 13 who are prescribed antipsychotics and have not received metabolic monitoring (glucose and cholesterol testing).
• Timeframe: August 2024

Gap in Care Reminder Calls

Independent Health’s Member Services team will perform telephonic outreach to provide education and encourage members with an open gap in care to reach out to their provider to schedule the appropriate appointments and/or get a prescription to complete the screening.

1. Medicaid Managed Care (State program) members who have open gaps for: breast cancer, colorectal, and/or cervical cancer screenings.
2. Medicare Advantage members who have open gaps for: breast cancer, colorectal, and/or eye exams for members with diabetes
3. Commercial (HMO/POS) members who have open gaps for colorectal cancer screenings

• Timeframe: Call campaign began in August and will run throughout 2024

Social Determinants of Health Screening

This telephonic outreach campaign will engage targeted Medicare Advantage members in a conversation around screening for social determinants of health to identify any needs the member has for food, housing, and/or transportation.  If a need is identified, Independent Health will assist the member in making a connection to a community resource to address the need. 

• Outreach method: Outbound telephone call campaign
• Target members: Medicare members identified with social risk factors including those with low-income subsidy or dual enrollment in Medicaid
• Timeframe: Call campaign began in June and will run throughout 2024

• View the policy changes for the Third Quarter of 2024. You must be logged into the provider portal to view the changes.
• Search for and view the most current versions of Independent Health’s drug 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. To view Magellan Rx policies for the drugs they review, click here.
  

Drug Formulary Changes

View the formulary changes for the Third Quarter of 2024 and the formulary changes for 2025 approved at the August Pharmacy and Therapeutics Committee meeting. 

Independent Health's drug formularies
Access Independent Health's drug formularies here.

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.