Provider Update
This quarterly newsletter reports on business and clinical news, including a summary of clinical updates, continuing education opportunities, and drug formulary updates. Newsletters are available online for one year.
Highlights include:
- Increased scrutiny surrounding controlled substance prescribing
- MAC prior authorization no longer required for Gastrointestinal Endoscopic Procedures
- Billing codes and names of policies being replaced
- Optum prepay claim reviews underway
- Recent letters to providers
- Addressing the national Ozempic shortage
Highlights include:
- Washington Permanente Medical Group welcomes new Executive Medical Director
- Kaiser Permanente recognized as a Top 100 honoree
- Kaiser Permanente recognizes top quality performing clinics
- Changes to medical necessity review criteria
- ASCVD prevention guideline updates
- Continuing medical education events
Highlights include:
- Introducing new Kaiser Permanente Washington regional president
- New toolkit for persistent pain
- Biosimilar adalimumab-atto (Amjevita) now available
- Member health goals workshops
- Recent letters to providers
- Continuing medical education events
Highlights include:
- Mental Health access for Kaiser Permanente members
- Claims address change for select self-funded plans
- SEBB network changes
- Recent letters to providers
- Pharmacy First-Fill initiative expands
- Continuing medical education events
Highlights include:
- Advanced Care at Home program starts in October
- Take our Practitioner Satisfaction Survey
- Olympia Medical Center is tops
- Sexually Transmitted Infection Guideline updated
- Clinical and pharmacy news
- Continuing medical education events
Highlights include:
- New Advanced Care at Home program
- Enhancements to Eligibility & Benefits Inquiry tool
- Recent letters to providers
- Updates to opioid naïve definitions
- Continuing medical education events
Highlights include:
- Authorization no longer required for mental health outpatient therapy/psychiatry
- Reimbursement for rapid antigen home tests
- HR 133 legislation update
- 2022 drug formularies
Highlights include:
- The No Surprises Act: Updates and information
- Medicare news
- New member ID cards on the way
- Optical and hearing hardware changes
- Kaiser Permanente to partner with National Transplant Services
Highlights include:
- Kaiser Permanente making COVID-19 vaccines mandatory for all its employees and physicians
- Should I use chart access message or referral message in Affiliate Link?
- Medicare coordination of benefits
- Affiliate Link enhancement: Referral notifications now viewable as a printable PDF
- Changes to home infusion and ambulatory infusion suite place of service coding for prior authorizations and billing
- Requesting physical therapy services for Access PPO members
- Recent letters to providers
- New prior authorization criteria for Descovy when used for PrEP
- New acute benzodiazepine quantity limits beginning October 1, 2021 for commercial members
- Kaiser Permanent 2021 drug formularies
Highlights include:
- New Affiliate Link re-authorization process now available for providers
- Change to how Affiliate Link users access referral notifications
- Streamlining Mental Health & Wellness authorization and reauthorization requests
- Always verify patient coverage prior to visit
- Communication is key in tragic emergency department situations
- Infusion site of care criteria
- Recent letters to providers
- Diagnosis Related Group post-pay reviews begin
- Primary hrHPV is now default test for Cervical Cancer Screening
- Asthma Diagnosis and Treatment Guideline update
- Updated recommendations for gonorrhea treatment in patients and their partners
- Kaiser Permanent 2021 drug formularies
Highlights include:
- Focus on member satisfaction: What is the Medicare CAHPS survey?
- First call guide for ambulance partnerships for Kaiser Permanente
- HEDIS® medical record review season: February-May 2021
- CMS and Department of Health COVID-19 vaccination information added to provider site
- Vaccination help for Washington state schools employees
- Streamlining Mental Health & Wellness authorization and reauthorization requests
- Threshold decrease for claims pre-payment and medical necessity review for inpatient and outpatient claims
- Routine hepatitis C screning now recommended for all adults - not just baby boomers
- New guideline provides treatment options for patients with opioid use disorder
- Kaiser Permanente 2021 drug formularies
Highlights include:
- Introducing new networks, plans, and initiatives for 2021
- New VerifyHCP® clinician directory verification panel
- Changes to our Women's Health payment policy
- COVID-19 Household Prevention program resources available to our members
- Recent letters to providers
- New and updated payment policies
- Tips on how to navigate the prescription drugs prior authorization process
- Acupuncture Medicare benefit for chronic low back pain
- Updated ASCVD prevention guidelines
- 2021 summary of opioid prescribing edits
- Kaiser Permanente 2021 drug formularies