Provider Monthly: New authorization tool, updated drug fee schedules, and revised medical policies in August 2021

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id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text">Provider Monthly: New authorization tool, updated drug fee schedules, and revised medical policies in August 2021</span></li> </ul> </div> </div> <div class="pst_mdsec"> <div class="article__hero"> <h1 class="node-title"> <span class="field-wrapper"><span id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text">Provider Monthly: New authorization tool, updated drug fee schedules, and revised medical policies in August 2021</span></span> </h1> <div class="article__meta"> <div class="cardwi__date"> <time>August 01, 2021</time> </div> <div class="cardwi__category"> Providers </div> </div> </div> <div class="content-wrapper"> <div class="blog-post__body"> <span id="hs_cos_wrapper_post_body" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="rich_text"><div> <div id="hubspot-author_data" data-hubspot-form-id="author_data" data-hubspot-name="Blog Author"> <h2><span style="text-decoration: underline;"><span style="color: inherit; font-size: 2.25rem; background-color: transparent; font-weight: bold; text-decoration: underline;">Featured Story:</span></span></h2> <h2>Five tips to ensure providers’ success with new Authorization Process for High-Tech & Cardiac Imaging</h2> <p>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.</p> <ol> <li><strong>Select the appropriate requested service</strong><br>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.</li> </ol> <p><img src="https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=453&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg" alt="happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139 (1)" width="453" loading="lazy" style="width: 453px; margin-left: auto; margin-right: auto; display: block;" srcset="https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=227&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg 227w, https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=453&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg 453w, https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=680&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg 680w, https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=906&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg 906w, https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=1133&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg 1133w, https://massgeneralbrighamhealthplan.org/hs-fs/hubfs/happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg?width=1359&name=happy-doctor-talks-with-patient-during-telemedicine-appointment-picture-id1254705139%20(1).jpg 1359w" sizes="(max-width: 453px) 100vw, 453px"></p> <p style="text-align: center;"><a href="https://bestpractice.allwayshealthpartners.org/five-tips-to-ensure-providers-success-with-new-authorization-process-for-high-tech-cardiac-imaging" rel="noopener" target="_blank">Keep reading</a></p> <div data-hs-responsive-table="true" style="overflow-x: auto; max-width: 100%; width: 100%; margin-left: auto; margin-right: auto;"> <table style="border-collapse: collapse; table-layout: fixed; margin-left: auto; margin-right: auto; width: 100%; border: 1px solid #FFFFFF; height: 97px;"> <tbody> <tr> <td style="width: 100%; padding: 4px; background-color: #e9741c;"><span style="color: #ffffff;">To view last month's newsletter or any previous month, visit our <a href="/administrative-newsletter-archive" rel="noopener" target="_blank" style="color: #ffffff; text-decoration: underline;">Admin Newsletter Archive.</a></span></td> </tr> </tbody> </table> <p><span style="text-decoration-line: underline; background-color: transparent; font-size: 1.25rem;">In this issue:</span></p> </div> </div> </div>  <div> <ul> <li><span>AllWays Health Partners’ Drug fee schedules to be updated</span></li> <li><span>Hospital inpatient utilization report</span></li> <li><span>Revised medical policies</span></li> <li><span>Code updates</span></li> <li><span>Formulary updates</span><br><span></span></li> </ul> <hr> <h3><span>AllWays Health Partners’ Drug fee schedules to be updated</span></h3> <p><span>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.<br><br>The next update will occur on October 1, 2021. 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.<br></span></p> <hr></div> <h3><span>Hospital inpatient utilization report</span></h3> <p><span>The latest quarterly hospital inpatient utilization report is now available. To review this report, click on the Reports tab in the Provider Portal and select Clinical Reports. If you do not have access to the Provider Portal, you may register online at </span><a href="http://allwaysprovider.org/" rel=" noopener">allwaysprovider.org</a><span>.</span></p> <hr> <h3>Medical Policy Updates -August 1, 2021 Effective Date</h3> <p>Four medical policies were reviewed and passed by the AllWays Health Partners Medical Policy Committee. These policies are now posted to allwayshealthpartners.org. <br><br>The table below is a summary of the policies and the changes:</p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-11-26-48-31-AM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-08-11-16-10-PM.png" loading="lazy"></p> <p>For more information or to download our medical policies, go to <a href="https://www.allwayshealthpartners.org/providers/medical-policies" rel="noopener" target="_blank">allwayshealthpartners.org/providers/medical-policies</a> and select the policy under the medical policy listings.</p> <hr> <h3>Code Updates</h3> <p><span style="text-decoration: underline;"><span style="font-weight: bold;">CPT Code Updates</span></span><br>As a reminder to our network the following service is not covered across all lines of business:</p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-11-25-46-98-AM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-11-28-41-23-AM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-11-29-33-48-AM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-11-30-45-41-AM.png" loading="lazy"></p> <hr> <h3>Formulary updates</h3> <p style="font-weight: bold;">Effective date: 10/01/2021</p> <p><span style="text-decoration: underline;"><span style="font-weight: bold;">Updates for Commercial Members</span></span><br>The following changes are being made to the listed medications:</p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-09-46-14-73-PM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-09-47-18-77-PM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-09-48-19-04-PM.png" loading="lazy"></p> <p><img src="https://massgeneralbrighamhealthplan.org/hubfs/image-png-Jul-29-2021-09-48-52-09-PM.png" loading="lazy"></p></span> </div> </div> </div> <section class="blog-related-postss"> <div class="content-wrapper"> <h2>Related Articles</h2> <div class="blog-related-posts__list"> <div class="post-item"> <a href="https://massgeneralbrighamhealthplan.org/admin-newsletter/provider-monthly-new-behavioral-health-resource-webpage-allies-update-and-recognizing-breast-cancer-awareness-month-during-october-2021" class="cardwi cardwi--article"> <div class="cardwi__meta"> <div class="cardwi__category"> Providers </div> <div class="cardwi__date"> <time>10.04.2021</time> </div> </div> <div class="node-title cardwi__title"> <span class="field-wrapper">Provider Monthly: New behavioral health resource webpage, Allies update, and recognizing Breast Cancer 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Provider Monthly: New authorization tool, updated drug fee schedules, and revised medical policies in August 2021