Point32Health has appointed Glenn Pomerantz, MD, JD as our new Chief Medical Officer. He oversees clinical innovation, quality and accreditation, medical policy, and the Harvard Pilgrim Health Care Institute, which includes the Department of Population Medicine at Harvard Medical School.
Point32Health is delighted to share that we’re expanding our claims consultation series as part of our ongoing commitment to collaborating with our valued provider partners, and will be hosting events in October and November in Providence, RI; Canton, MA; Manchester, NH; Rocky Hill, CT; and Biddeford, ME.
Point32Health is pleased to share that we have developed new tip sheets related to the Kidney Health Evaluation for Patients with Diabetes (KED), Controlling High Blood Pressure (CBP, and Transitions of Care (TRC) HEDIS® measures.
With childhood and adolescent behavioral health concerns continuing to rise among health care professionals, we’d like to remind our provider partners about the importance of offering routine behavioral health screening during primary care visits
The Centers for Medicare & Medicaid Services and other regulatory bodies, as well as the federal No Surprises Act of 2021, require health plans to maintain and update data in provider directories — and we rely on providers to review their data and notify us of changes as they happen to ensure that members have access to accurate information.
Teenagers, like younger children, greatly benefit from regular check-ups and vaccinations, and these appointments are recommended annually for patients between ages 12-21. These visits allow providers to assess their overall well-being, address risky behaviors, and detect conditions which could affect the teens’ future development.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s medical drug program, including information about prior authorization and coverage, updated MNGs, and more.
As part of our overarching integration work as a combined company, Point32Health has developed the following integrated Point32Health Payment Policies.
If you treat patients with opioid use disorder, please keep in mind some recent federal changes regarding the X waiver requirement for prescribing buprenorphine, as well as training requirements for prescribers.
After the resounding success of the July claims consultation event we hosted at our Canton, MA headquarters, Point32Health is delighted to share that we’re expanding the series beyond Massachusetts and offering events in other states.
To avoid denials based on missing information needed for Point32Health to conduct a complete prior authorization review, and to avoid delays in patient care, please respond back timely to requests for more information.
The flu season runs from October through April each year, and given the ongoing COVID pandemic, it’s particularly important to emphasize the importance of getting the 2023-2024 flu vaccine to your patients.
Reducing hospital readmissions within 30 days is a considerable priority in health care, leading to increased patient satisfaction and improved outcomes.
Patients taking antipsychotic medications are at increased risk of developing health conditions including diabetes, high blood pressure, abnormal cholesterol and triglyceride levels, and obesity. Yearly screening and regular metabolic monitoring is vital for children, adolescents, and adults on these medications.
As a follow-up to our July 2023 communication regarding the Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measure, which assesses the follow-up care patients receive after a new episode of substance use disorder (SUD), we’d like to offer some additional tips to keep in mind.
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
As part of our overarching integration work as a combined company, Point32Health has developed the following new, integrated Point32Health Payment Policies.
As a reminder, Point32Health provides coverage for treatment of pelvic floor disorders. Members are eligible to receive clinical evaluation and physical therapy (PT) as outlined in their plan benefits, and providers should use diagnosis code 090.89 when billing for PT for pelvic floor disorders.