Welcome to Summit Health
As a valued Summit Health partner, we appreciate your commitment to providing the highest quality care to our members. To keep you informed and make sure you have what you need to continue providing excellent care to your patients, we’re excited to announce the first issue of the Summit Health Provider Newsletter.
This monthly digital publication will share valuable information and updates related to quality and operations for Summit Health to providers, like you, who practice within the Summit Health service area.
Below is a preview of the articles you will find in this month's issue:
To ensure we are providing the information you need to deliver better care to your patients, we would love to hear from you. Please let us know if you have any questions, concerns or recommendations on topics that we can include in future issues.
Thank you,
Your Summit Health Team
The Summit Health team is beginning our end-of-year clinical quality measure data collection process for clinics who participated in the 2021 Medicare Advantage Primary Care Incentive Program (MAPCIP).
For the 2021 measurement year, four of the quality measures included in the MAPCIP are clinical quality measures (CQMs), meaning they are based on data pulled directly from practice electronic health record (EHR) systems. These measures are:
Summit Health is allowing providers to submit a summary report of measure results instead of patient-level data. Either Summit Health-specific or all-payer data is acceptable. The data must be submitted via an Excel template, similar to reports for EOCCO CQMs. The template was distributed on 12/22/21 to 2021 MAPCIP participating providers. Specific instructions are included in the Excel template, and you must attest that the data is accurate. If you did not receive it, please reach out to providerreports@modahealth.com.
Clinical quality measure performance summary reports must be submitted to providerreports@modahealth.com by March 4, 2022 to be eligible for the 2021 Performance Based Incentive Payment.
We commit to working with you to bring better health and overall wellness to your patients by conducting outreaches throughout the year to your patients and your clinic. These programs aim to encourage your patients to close recommended preventive services, follow-up with those who recently discharged from inpatient stays, and provide support for high-risk patients.
To keep you informed of the member- and provider- outreach programs that Summit Health conducts, access our 2022 Summit Health Provider Quality Initiatives Calendar.
Summit Health covers COVID-19 vaccines and approved booster doses at no cost to beneficiaries in accordance with guidance of the Centers for Medicare and Medicare Services (CMS). Please take note to prevent avoidable billing errors.
For more information about COVID-19 vaccine policies and guidance, please visit www.cms.gov/COVIDvax.
Starting in January 2022, Summit Health Plan will be performing a Medicare Advantage Risk Adjustment chart review for patients who may have been seen in your office. Chart reviews are necessary to assure that payments made to Summit Health by the Centers for Medicare and Medicaid Services (CMS) are accurate and sufficient to cover services provided. If your site has provided services to our member(s), you will receive a request for their records, with all details outlined within that notice. Once received, please send the records to the Summit Health Risk Adjustment Process Team within 7 – 10 business days.
We are able to accept records via fax, secure email, secure upload to SFTP, and remote EMR access. If your site is open to allowing Summit Health Plan remote EMR access, please contact Risk Adjustment Process Team to establish connection. This is the most efficient and cost-effective way to complete record retrieval and review.
For any other risk adjustment questions, please email risk@yoursummithealth.com or call the Risk Adjustment Process Team 503-265-4765.
Summit Health members may see a change in the cost for diabetic supplies including Blood Glucose Monitor (BGM), Continuous Glucose Monitor (CGM), insulin pump, and the related supplies for these devices.
Due to a system error, the in-network 20% coinsurance may not have been applied correctly in 2021. Starting Jan. 1, 2022, our system will apply the correct 20% coinsurance. We will be informing members with medical and/or pharmacy claims related to these diabetic supplies, so they are aware of this change.
There is no need to change how you support and manage the health of your patients with diabetes. Your patient may be able to save money by getting their diabetic devices and related supplies from another in-network Durable Medical Equipment (DME) supplier or in-network pharmacy. You may need to submit a prior authorization (PA) if your patient chooses to switch where they get their supplies.
Our EOCCO and Summit Health Quality Improvement (QI) team provides concierge support through dedicated QI staff, clinic trainings, and regular touchpoints.
Please contact EOCCOmetrics@modahealth.com to schedule an introductory meeting, if interested.
Questions related to EOCCO & Summit Health Quality Measures?
Please email EOCCOmetrics@modahealth.com
Questions for Provider Relations?
Please email Noah Pietz at ProviderRelations@yoursummithealth.com
Questions related to Risk Adjustment?
Please email risk@yoursummithealth.com
If you would like to be added or removed from this email list, please let us know at ProviderInquiry@yoursummithealth.com
Last updated Oct. 1, 2023
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