Welcome to Summit Health
Welcome to the July issue of the Summit Health Newsletter. As a valued Summit Health partner, we appreciate your commitment to providing the highest quality care to our members.
Below is a preview of the articles you will find in this month's issue:
Visit archived newsletters here.
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
Summit Health has recently sent our third-quarter care guide earlier this month to educate and help your patients schedule their recommended preventive services. We ask that you work with your patients on their open gaps in care and complete those that are appropriate for their overall health management.
These guides are personalized for your patients based on their medical and pharmacy claims information. They will remind your patients about services for which they may be due, including Annual Wellness Visits (AWV), cancer screenings, routine diabetes care, and more.
Many of these are directly tied to Star Measures, and others have an indirect opportunity to impact quality measures. Closing these care gaps can lead to better health outcomes.
An AWV and the Annual Physical Exam can be completed at the same visit and can also be combined with a problem visit, but a cost-share would apply if combined with a problem visit. Please be sure to code services accurately, for both your own reimbursement and quality measure reporting. Learn more about Medicare Preventive Services at the Medicare Learning Network.
For Summit Health, we have removed the Prior Authorization requirement for Durable Medical Equipment (DME) that costs over $250. This PA requirement was removed effective 6/1/2022. DME that require a PA by a specific procedure code still has an authorization requirement in place.
In March, the National Committee for Quality Assurance (NCQA) announced updates to their Healthcare Effectiveness Data and Information Set (HEDIS) technical specifications for Measurement Year 2022. The changes included lowering the age range for the Colorectal Cancer Screening measure from 50 – 75 years of age to 45 – 75 years of age.
For the 2022 Medicare Advantage Primary Care Incentive Program (MAPCIP), the quality measure will be updated to reflect the lowered age range to align with HEDIS tech specs and CMS Medicare Preventive Guidelines.
Summit Health has also updated our member benefits for colorectal cancer screening services to address the lowered age range. Note that the (*) indicates if a service meets numerator compliance for HEDIS.
| Service | Updated Colorectal Cancer Screening Benefits |
| CT colonography* |
Age: 45 – 75 Frequency: 5 years Cost share will apply since this is not a preventive screening and requires medical review |
| Guaiac-based fecal occult blood test (gFOBT) |
Age: 45+
Frequency: Once per calendar year No cost share with in-network provider. |
| DNA based colorectal screening* |
Age: 45+
Frequency: 3 years No cost share with in-network provider. |
| Screening barium enema |
Low Risk
Age: 50+
Frequency: Once every 4 years High Risk Age: No age minimum or limit Frequency: Once every 2 years No cost share with in-network provider. |
| Screening colonoscopy* |
Age: No minimum or limit
Frequency: Low risk (based on CPT) every 10 years; and high risk (based on CPT) every 2 years No cost share with in-network provider. |
| Screening flexible sigmoidoscopy* |
Age: 45+
Frequency: 4 years No cost share with in-network provider. |
| Screening FOBT* |
Age: 45+
Frequency: Once per calendar year No cost share with in-network provider. |
To learn more about our 2022 MAPCIP, please email providerrelations@modahealth.com.
Summit Health Trainings and Support
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 a 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
Questions related to HEDIS Chart Collection?
Please email HEDIS@modahealth.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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