Summit Provider Newsletter - November 2023

End-of-Year Gap Closure and Preparing for 2024 Prior Authorizations

Welcome to the November 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:

• End-of-Year Quality Gap Closure
• Magellan Rx/Prime Therapeutics will Require Requested Authorization Duration Effective 1/1/24 for Medicare Members

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

End-of-Year Quality Gap Closure

As the busy holiday season approaches, we want to encourage you to support your Summit Health patients and close any quality gaps in the remaining months of 2023 that will count towards your Summit Health Medicare Advantage Primary Care Incentive Program (MAPCIP) incentive earnings.

• Be sure to see your patients for covered preventive visits
• Recommend that they complete and return their no-cost, at-home fecal immunochemical test (FIT) and/or a hemoglobin A1c test kits that they may have received from Everly Health last month
• Ensure your patients are up-to-date with their preventive vaccines, including updated flu and COVID-19 vaccines

For more information about covered preventive services, visit CMS Medicare Learning Network.

Magellan Rx/Prime Therapeutics will Require Requested Authorization Duration Effective 1/1/24 for Medicare Members

In compliance with Medicare Final Rules effective 1/1/241, prior authorization requests for specialty pharmacy medications submitted to Magellan Rx/Prime Therapeutics for Medicare members will require the requester to enter a requested number of days for the authorization duration for the requested drug regimen. Please be prepared to enter the requested duration on the provider portal (MrxGateway.com) or to provide this information verbally to the intake team if requesting an authorization by phone.

If this information is not provided at the time of the request, Magellan will be contacting the provider office to obtain this information. The provider’s requested duration must be provided before an authorization may be issued.

Please see the screenshot below illustrating where this new duration field will appear in the “Request Prior Authorizations” workflow on the Magellan provider portal MrxGateway.com. Please contact Magellan at 800-424-8114 with any questions.

Upcoming Events & Training

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 scheduled meetings to support your quality work.

Please contact EOCCOmetrics@modahealth.com to schedule an introductory meeting, if interested.

Questions?

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