Featured Story: Roadmap 2020
Our new Roadmap 2020 page will give you an overview of the enhancements we’re offering this summer and beyond. Be sure to bookmark the page and check back often — we’ll be updating the page with the latest news and announcements. If you haven’t already, you can also register for our monthly newsletters to be the first to learn about new updates.
In This Issue
- Introducing Roadmap 2020
- COVID-19 updates
- NEW: Behavioral health resources for PCPs
- Switching to InterQual 2020
- Formulary updates
- Medical policy
- Code updates
- Provider payment guidelines
- Reminder: Confirm your provider directory information
- Contact information
Introducing Roadmap 2020
Our new Roadmap 2020 page will give you an overview of the enhancements we’re offering this summer and beyond. Be sure to bookmark the page and check back often — we’ll be updating the page with the latest news and announcements. If you haven’t already, you can also register for our monthly newsletters to be the first to learn about new updates.
Big changes to our authorization process, products, and more
Two weeks ago, we posted about the improvements we’re planning to roll out for our outpatient authorization process. Soon, you’ll be able to search prior authorization requirements by code and receive immediate approvals for outpatient services. You’ll be able to get approvals 24 hours a day, 7 days a week. In addition, we’ve already lifted many prior authorization requirements across all lines of services that are currently managed by eviCore as of July 1.
We’re also introducing innovative new products to reduce cost and increase access to care. Beginning October 1, 2020, Allies will be available in partnership with Newton-Wellesley Hospital. Also coming soon is the Select Network, a new commercial limited provider network designed to offer members access to high-quality providers and comprehensive benefits at a lower cost.
In addition, we’re developing resources and tools to better serve you and your practice. We’ll soon be implementing updates right to our provider portal, making it even easier for you to check eligibility, see benefits, and more.
We’ve also created Provider Roundtable, an online forum where you can share your thoughts not only with your colleagues, but with us as well. Through surveys, discussion boards, and other means of communication, you can let us know directly what we’re doing well, what we could improve, and how we can make our products and services better. Network providers can click here to join Provider Roundtable today.
COVID-19 updates
Enrollment process for providers who are supporting practices during the COVID-19 state of emergency
Over the past several months, some practices have enrolled providers to support patient care during the state of emergency. Please remember to regularly review and validate your provider roster report. This report can be obtained in the Provider Portal.
If a provider continues with the practice after the state of emergency, they will need to be fully credentialed. You can initiate this process by submitting the provider's information along with the group NPI and TIN to PEC@allwayshealth.org.
If a provider does not continue with the practice after the state of emergency, they'll need to be processed for termination from the practice. Please submit the request to PEC@allwayshealth.org.
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
NEW: Behavioral health resources for PCPs
We're dedicated to ensuring that you have quick access to important resources and information - so you can spend more time providing care to your patients, and less time with administrative tasks. That's why we developed a new behavioral health resource page that centralizes behavioral health screening tools and other resources for primary care providers.
Visit our behavioral health resource page today.
Switching to InterQual 2020
To align with the latest industry standards, AllWays Health Partners updates our criteria at least annually. In September, AllWays Health Partners will move to InterQual 2020
InterQual Criteria Lookup Tool
You can view the current criteria in the InterQual Criteria Lookup Tool on the provider portal. When we switch to version 2020, the new criteria will be available.
Formulary updates
AllWays Health Partners regularly reviews and updates our formulary to ensure alignment with the industry. Check out the latest updates effective October 2020.
For the latest information on our pharmacy programs, visit our online formulary today.
Medical policy
The following medical policy updates are effective August 1, 2020:
- Arthrodesis for Sacroiliac Joint Pain – Annual review. References updated.
- Autologous Chondrocyte Implantation in the Knee - Annual review. References updated.
- Bone Stimulating Devices - Annual review. References updated.
- Prostheses-Upper Limb – Annual review.
- Prostheses-Lower Limb - Annual review. References updated.
The following medical policy update is effective October 1, 2020:
- Durable Medical Equipment (DME) - Annual review.
Code updates
Stay current on the latest code and reimbursement updates.
Check out the latest updates here.
Provider payment guidelines
The following provider payment guideline has been updated:
- Laboratory and Pathology Services
- Imaging Services
View all provider payment guidelines
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.
You can submit a provider information update request 24/7 through our secure Provider Portal or by submitting the Standardized Provider Information Change Form to pec@allwayshealth.org.