NEW PROVIDERS
- Filza Kita, DO of North Shore Pediatrics 480 Maple Street Suite 3 A Danvers, MA 01923 Phone: 978-406-4234 Fax: 978-921-2968. Anticipated start date 7/31/2023
- Shravya Vinnakota, MD of Lahey Cardiology, Beverly 75 Herrick Street Suite 206 Beverly, MA 01915 Phone: 978-927-8400 Fax: 978-922-1452. Anticipated start date 9/1/2023
PRACTICE CHANGES/UPDATES
- Lori Jurgens, DDS of Salem Peabody Oral Surgery has retired effective 4/10/2023
- Christian Ecker, MD of Beverly Radiological Associates has retired effective 5/1/2023
- Timothy Frey, MD of Beverly Radiological Associates has termed effective 5/9/2023
SAVE THE DATE
NP/PA Meeting
Date: Wednesday, July 26th, @ Noon
Speaker: Jillian Annesse, NP
Topic: Migraines
Location: Teams Meeting
RSVP: Alison.Wiklund@Lahey.org
NEWS FROM NEPHO
JUNE 2023 EDITION
IN THIS ISSUE:
WellSense MassHealth ACO Update – Notice to NEPHO Specialists
BILHPN Acuity Training for Epic Users
JULY POD MEETING CANCELATION
The July POD meetings will be canceled for 2023. All PCPs will receive credit for this meeting. Please look out for a short presentation and survey, which will be emailed to all POD invitees!
BILHPN TEXTING CAMPAIGN
BILHPN has two texting campaigns scheduled for July: Open Risk and Child/Adolescent Immunizations.
Open Risk
[Practice Name] @Beth Israel Lahey Health: Your health is important to us. If you have not yet scheduled a visit with your primary care provider’s office, please call [Practice Name] at [Practice Phone]. Regular care is vital to maintaining chronic conditions. To stop receiving messages, reply with ‘STOP’
Child/Adolescent Immunizations
Your child’s health is important. Regular well visits, which may include immunizations, are the best way to maintain your child’s health. Please call [Practice Name] at [Practice Phone] to schedule a visit and learn more about routine immunizations. To stop receiving messages, reply with ‘STOP’
If you have any questions regarding the BILHPN texting campaigns please contact Laureen Viel at Laureen.Viel@Lahey.org.
WELLSENSE MASSHEALTH ACO – NOTICE TO NEPHO SPECIALISTS
We have received the following guidance regarding the end of the Continuity of Care period, and specialists who may still be in the process of being credentialing with WellSense:
- Many elements of WellSense’s Augmented Continuity of Care Policy for new ACO members are expiring on July 4. WellSense established these policies for those ACO members who joined WellSense on April 1 as part of the 1115 MassHealth Demonstration Waiver’s renewal. Beginning July 5, these members will no longer be in a continuity of care period, and unless otherwise noted, they will be subject to all standard WellSense MassHealth ACO plan policies, including prior authorization requirements.
- The Continuity of Care (CoC) period allowed for our MassHealth patients to continue seeing specialists with whom they had an existing relationship, without requiring a prior authorization – even if that specialist was out-of-network with WellSense.
- Most BILH specialists have been or are actively in the process of being enrolled in the WellSense network. While primary care providers are all enrolled in our ACO contract, specialist providers participate with WellSense via their MCO contracts. As new providers join your practice, standard enrollment procedures should be followed in order to add the provider to the WellSense network.
- If you have not yet received a letter from WellSense confirming your enrollment and credentialing has been completed, you will need to hold on seeing WellSense patients or designate the care to one of your colleagues until you receive confirmation that your enrollment is finalized. Claims will reject if enrollment has not yet been completed.
- WellSense confirmed enrollment is now complete for 85% of NEPHO specialists. If you have questions regarding your enrollment with WellSense, you can use the Provider Lookup Tool to confirm status. Any outstanding enrollment still in process is anticipated to be complete within the next 60 days
- Once your enrollment is complete, you can see WellSense patients from any health system ACO (Specialists are not required to be exclusive to one ACO and can see patients across ACOs). Referrals to see WellSense patients are not required. However, some services may require prior authorizations. Services that require PAs can be found here.
- If you have any questions, the WellSense Provider Relations team can be reached at: Jeanette.Sanders@wellsense.org
PAYOR UPDATES
Blue Cross Blue Shield of Massachusetts
BCBSMA has Simplified the ABA Authorization Response Process
Starting June 1, 2023, the response providers receive from BCBSMA for Applied Behavior Analysis (ABA) authorization requests will look different. If the request is approved, instead of receiving a varying number of authorizations based on the requested services, providers will now receive the following two authorizations: One for ABA Assessment (Behavior Identification Assessment); One for ABA Treatment (all other ABA services). To view the complete notification, click here.
Medical Policy Announcements
This document announces new medical policy changes that take effect September 1, 2023. To view the list, click here.
Authorization Manager Requirement: Are Providers Ready?
Are providers ready to use Authorization Manager? As a reminder, all providers will be required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax starting June 1, 2023 for the commercial (HMO, PPO) and Federal Employee Program (FEP) members. Authorization Manager is the most efficient method to submit requests, and it’s available 24/7 at no additional cost via single sign-on through Provider Central. To view the complete notification, click here.
Fallon
Product Reference and Member ID Card Guide
Fallon Health posts a current Product Reference and Member ID Card Guide to the website. To view the guide, click here.
Medicare
Medicare NCCI Add-on Code Edits Effective July 1, 2023
The updated ZIP file has been posted to the website to become effective July 1, 2023. To view the file, click here and locate the file in the downloads section.
Physician Fee Schedule – July 2023 release RVU23C
The updates for July includes only codes with a non-active status. Given this, the April payment PUF is empty for the July 2023 release. To view the ZIP file, click here and locate the file in the downloads section.
Tufts Health Plan
Evaluation and Management Professional Payment Policy Update
The policy has been updated as follows: Added billing information for provider-to-provider e-consults for Tufts Health Together, Tufts Health Unify, and Tufts Health Plan SCO, effective for DOS on or after April 1, 2023, in accordance with MassHealth APB 364. To view the complete policy, click here.
Payment Policy Update: Preventive Services
The policy has been updated as follows: Added codes Z00.00, Z00.01 to the Chlamydia Screening section for Adults, all codes were removed from the Abdominal Aortic Aneurysm section except code 76706, Removed listing of Aspirin < 325mg as no longer a covered preventive pharmacy benefit, removed brand name bowel preparations from a covered preventive pharmacy benefit, updated fluoride to include children age 6 months through 16 years, reformatted Medications section. To view the complete policy, click here.
Tufts Health Public Plan
Please be aware that the address for Tufts Health Public Plans initial paper claim submissions is changing. Starting August 1, 2023, initial paper claims for both Massachusetts and Rhode Island Public Plans should be sent to the address indicated in this article. For more information, click here.
Telehealth reimbursement for Tufts Health Direct members
Effective Aug. 1, 2023, we will reimburse services provided via telehealth to Tufts Health Direct members at 80% of the in-person rate, consistent with our current reimbursement for commercial Harvard Pilgrim Health Care and Tufts Health Plan members in Massachusetts, Rhode Island, and Maine. For more information, click here.
PHARMACY UPDATE
Please see the updated Inhaler charts currently available:
2023 Updated BILH Inhaler Coverage Chart
2023 Updated BILH Quick-View Inhaler Coverage Chart
2023 Updated BILH Inhaler Selection Guide
Copies are also available on the NEPHO website @ www.nepho.org.
BILHPN Pharmacy Newsletters:
Please see BILHPN Pharmacy newsletters with current pharmacy related issues. You can access past issues by using the www.nepho.org Website under Pharmacy Resources*.
*please note, a password is now required to log into Pharmacy Resources on the www.nepho.org website. If assistance is needed, please contact Alycia Messelaar at Alycia.Messelaar@lahey.org.
For more information, please contact Carol Freedman at carol.freedman@lahey.org or at 978-380-4089.
POPULATION HEALTH UPDATE
Zappix Text Messaging Platform for GI Patients
- This is a text messaging platform that was implemented by North Shore GI and Essex Surgical May 2023
- The patient will receive a text with detailed and personalized prep instructions:
- The day after booking their colonoscopy
- 21 days prior to the procedure
- 7 days prior to the procedure
- 3 days prior to the procedure
- 1 day prior to the procedure
- The day of the procedure
- The patient will also receive instructions via email and USPS mail
- The patient may opt out of texting and emails
- If the patient has questions, they can call the phone number listed within the text or they can text back (Monitored by GI staff)
Tu Salud Latino Health Fair @ Fenway Park
- Ali Wiklund, FNP and Dr. Fatima Reyes, OB/GYN provided information in Spanish and English on cervical cancer prevention and screening
- A one-page educational handout was available in both languages
- A QR code was available to scan and register for the November 13th Cervical Cancer Symposium (Via Zoom)
PROVIDER RELATIONS
Please take a moment to share this newsletter with staff members to ensure they are being kept up-to-date with important information.
Please click here to take a moment to read the Provider Spotlights!
If you would like to be featured on the PHO website, please reach out to Alycia Messelaar at Alycia.Messlaar@Lahey.org or 978-236-1784.
Virtual Networking videos from NEPHO providers can be found here.
Please reach out to Alycia Messelaar at Alycia.Messlaar@Lahey.org if you are interested in being featured in a Virtual Networking video.
Click here for the PDF version of the updated PHO Directory as of June 2023. For your convenience, click here for the separate Specialists Only PDF directory to refer to as needed.
Please share this directory with your office by printing or showing them how to visit us online for an easy to use directory search tool.
Note: Primary care providers (PCPs) in the BILH Performance Network no longer need to submit an administrative referral to refer Blue Cross Blue Shield of MA, Harvard Pilgrim Health Care, or Tufts Health Plan members to a specialist in the BILH Performance Network. Please reach out to Alycia Messelaar at Alycia.Messelaar@Lahey.org regarding questions pertaining to providers within the BILHPN Network.
As a reminder, it is important to use the NEPHO Physician Directory when referring to a specialty physician.
Here are the key memos that have been sent out over the last month – JUST in case you missed it!
- Monthly BILH Pharmacy Newsletters
- Monthly BILHPN BMC WellSense MassHealth ACO Newsletter
- Monthly Beth Israel Lahey Health Performance Network CDI Newsletter
- HPHC Cybersecurity Updates
- NECoMG Annual Meeting Evaluation
- WellSense PCP Cap Payment Details
- Office Manager Meeting – Click here to view, download and print the slides
- Boston Children’s Hospital
- Summer 2023 Satellite Provider Schedules
- BCHMedEd June Newsletter | See Upcoming Courses
Please reach out to Alycia.Messelaar@lahey.org for a specific communication that you are unable to find.
REFERRAL MANAGEMENT UPDATE
The BILH Spotlight
For patients that require care outside of our NEPHO network, Beth Israel Lahey Health provides a range of comprehensive otolaryngology services for patients, including state of the art evaluation, advanced, multidisciplinary treatment and follow up care.
These services have recently been sent to out of BILHPN providers when services are available at Beth Israel Lahey Health. Please click on the links below for more information.
BILH Hearing/Cochlear Implant Program
If you have questions, please feel free to contact Ann Cabral, Referral Manager, at Ann.Cabral@Lahey.org or 978-808-5379 to verify whether providers are available within the BILHPN network.
QUALITY DEPARTMENT UPDATES
- Lists of patients due in 2023 for cancer screenings will go out the month of June for Blue Cross Blue Shield HMO.
| Monthly | Needs Appt | DM & HTN | Outreach list for DM/HTN patients who need outreach for an appointment or an order for an HbA1c. All Commercial Payers |
| Mar/Jun/Sep | Cancer Screenings | BCBS HMO | Outreach list for patients who need a mammogram, pap smear or colonoscopy/FIT. BCBS HMO |
| Mar/Jul/Oct | Cancer Screenings | BCBS PPO | Outreach list for patients who need a mammogram, pap smear or colonoscopy/FIT. BCBS PPO |
| Mar/Aug | Cancer Screenings | HPHC/THP/Cigna | Outreach list for patients who need a mammogram, pap smear or colonoscopy/FIT. HPHC, THP. Cigna BC Only |
| Mar/May/Jul/Sep | Chlamydia & HPV Imms | CHL/HPV | Outreach list for BCBS & Cigna patients who need chlamydia screening. HPV Imms for BCBS only |
| Apr/Jun/Aug/Oct | Well Child 3-21 & WC 15 Months | WC3-21 | Outreach list for HPHC & Cigna patients who need an annual well visit. Well Child 15 months is for Cigna Only |
| Jun/Sep | PCP Scoreboards | All | YTD PCP Quality Performance |
- Key Takeaways:
- Breast Cancer Screenings (Ages 50-75) – The payer quality measurement for breast cancer screening still begins at age 50, so the patient lists include women ages 50-75 who are due for screenings in 2023 as identified by their health plan. However, the United States Preventative Services Task Force recently changed the starting age for screening mammograms back to age 40 from age 50.
- Cervical Cancer Screenings (Ages 21-64) – Women under the age of 30 are due for a pap smear only every 3 years. Women over the age of 30 need high risk HPV testing, (hrHPV) every 5 years or a pap smear with a hrHPV test every 5 years.
- Colorectal Cancer Screenings (Ages 50-75) – Patients and providers have a number of options based on the patient’s medical diagnosis and family history. The following options will satisfy this measure:
- Colonoscopy every 10 years or earlier depending on diagnosis
- FOBT test every year
- Flexible Sigmoidoscopy every 5 years
- CT Colonography every 5 years
- Stool DNA with FIT test (Cologuard) every 3 years
- Please follow up with patients who have care gaps and that are overdue to be seen for primary care visits.
- Please book appointments for these gaps as needed.
If you have any questions about the cancer screening measures or the lists, please reach out to the Quality or Population Health Team. We appreciate all your help. We are here to support you and greatly appreciate your partnership. Thank you!
TELEHEALTH RESOURCES
Quick Reference Guide to Health Plan TeleHealth Policies
- MassGeneral Brigham Health Plan
- BCBS of MA
- Commonwealth Care Alliance
- Cigna
- Fallon
- Harvard Pilgrim Health Care
- Tufts Health Plan
- Tufts Medicare Preferred
- Tufts Health Public Plan
- Unicare
Lahey Epic Users: Changes to Telehealth Smart Phrase Beginning May 18
The telehealth smart phrase “.TELEHEALTHDOCUMENTATION” has been updated.
- Audio-only visits must be billed solely based on time spent on the call with the patient and that time must be documented in the note
- This information will be required if audio-only is selected in order to ensure time spent with patient on the call is documented As a reminder, the only approved video modalities are Epic Video and Doximity Video. You will no longer have the option to select other modalities. This will be reflected on the new smart phrase as well.
BILHPN ACUITY TRAINING FOR EPIC PROVIDERS
Below is a list of dates for BILHPN Acuity Training for Epic users and a link to the recording of the September 12, 2022 Session. Click on each date to register.
Provider Acuity Training Series with CME Credit
Click here to request access to view the Recording for the September 12th Provider Acuity Training Series Session.
July 18, 2023, from 5:30 – 6:30 p.m.
Arcadia Acuity Trainings
CLINICAL DOCUMENTATION IMPROVEMENT
OPTUM NEWSLETTER – June – Focus on: Chronic obstructive pulmonary disease (COPD)
Please click here to view the 2023 Optum webinar schedule.
Various medications can weaken a patient’s immune system and there is a higher risk for infection. Therefore, it is important to identify a patient who is immunocompromised due to medications.
- Coding Tip: Use these two codes together AND add it to the patient’s problem list when the patient is taking an immunosuppressing medication
D84.821, Z79.899 Immunosuppression due to drug therapy
Examples of Some Immunosuppressing Medications:
- Adalimumab (Humira)
- Infliximab (Remicade)
- Ustekinumab (Stelara)
- Risankizumab (Skyrizi)
- Upadacitinib (Rinvoq)
- Long Term Glucocorticoids
Please reach out to Jessica Bryan at Jessica.M.Bryan@Lahey.org with questions or concerns regarding this clinical documentation tip or any other coding guidance.
PATIENT EXPERIENCE COMMENTS
Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road
- Dr. Spencer Amesbury has been my Primary Care Doctor for many years and I continue to have a high level of comfort with him at visits and lots of confidence in his health guidance to me. Superb at being a doctor.
- This was my first visit with Dr. Karenjeet Chahal and she’s fantastic! I’m so glad she is my new PCP.
- I receive excellent care from Dr. Gail Ellis. I have referred several friends to your practice.
- Dr. Neeraj Mahajan is wonderful – through doctor -pleasant- takes his time with you- such a HAPPY side to him!
Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203
- Dr. David Driscoll has always demonstrated excellent clinical expertise; I recommend him to friends and loved ones.
- Dr. Deborah Shih is always very helpful and informative. The staff at this office are friendly and professional.
Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center
- I’ve been a patient of Dr. Pierre Ezzi for many years. He is an excellent physician – he is never late for an appointment, and I always feel comfortable discussing my medical issues with him.
Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center
- Dr. Andrew Lenhardt is an excellent physician and I am truly blessed that I am in his care. He listens to me carefully and will implement my suggestions if they are applicable. I always look forward to my office visits.
- Dr. Daniel McCullough is excellent – always listens, is kind and professional.
Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street
- I had a positive experience, the staff was very professional and Dr. Brent Fryling was kind and thorough.
Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street Suite 204
- Dr. Kristina Jackson never ceases to amazing me the way she makes time for urgent calls, conveys empathy and problem solving in a brief meeting and always makes us feel heard and satisfied with care received.
- Dr. Timothy Loughran is an excellent physician and smoothly operating office. Refreshing to find such care nowadays! Thank you to all. I have recommended this office to several people.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 1st Floor
- Dr. Amy Esdale and Theresa are amazing. They are so attentive and kind. Very thorough and professional with wonderful medical advice and I’m happy this is my PCP office.
- Dr. Kathryn Hollett is the best, most caring doctor I’ve ever had! The staff have always been great to me would not change them ever.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- Dr. Victor Carabba is a fantastic doctor, always caring, respectful and professional. All of the staff are exceptional.
- Dr. Karen Damico was extremely empathetic and caring.
Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
- I’ve been a patient of Dr. William Medwid for many years. He and the staff at Family Medicine have always treated me professionally and with courtesy. I have recommended this office to others.
Beth Israel Lahey Health Primary Care, Manchester – 195 School Street
- Dr. Jana Oettinger was great!! So kind and took time to listen to everything I wanted to talk about.
- Dr. Matthew Plosker is fantastic. By far, the best doctor I’ve ever had. I plan on staying with him forever. Thank you!
Blackburn Primary Care, Gloucester – 1 Blackburn Drive
- I have been very happy with Dr. Jay Isaac and Blackburn Primary Care. They are very knowledgeable, compassionate and available as needed. I have recommended him to both family and friends and will continue to do so.
Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive
- Dr. Brian Orr is the best doctor for kids in my opinion. He is very nice and patient with my kids.
Cape Ann Medical Center, Gloucester – 1 Blackburn Drive
- Dr. Janet Doran is a good listener, asked questions (this was my first appt with her). She was patient and took my thoughts into consideration in planning next steps. Very satisfied with the care I received.
- My visits with Dr. James Maguire and his PA’s are always excellent and informative. My visits with the office staff are always excellent and professional.
- Dr. Shawn Pawson always shows he cares and is thorough, providing excellent service. Very highly recommended.
Cape Ann Pediatricians, Gloucester – 298 Washington Street
- We are so grateful to Dr. Jeffrey Stockman and his staff. We always feel like they truly care about our children and make every effort to see them ASAP as needed.
Danvers Family Doctors, Danvers – 140 Commonwealth Avenue
- I feel fortunate that Dr. Subroto Bhattacharya and his staff are my health care providers. I find them to be courteous, knowledgeable and willing to listen to my comments openly and without judgement.
Essex County Primary Care, South Hamilton – 42 Asbury Street
- Dr. Nicholas Avgerinos treated me with care and respect. We reviewed details of my medical history, and he answered any questions I had.
Garden City Pediatrics, Beverly – 83 Herrick Street
- Dr. Elizabeth Humphreys is amazing. She’s thoughtful, caring, and welcoming.
- Dr. Ian Sklaver is always very professional, kind, warm and caring.
- We continue to be happy with Dr. Eric Sleeper and the entire Garden City Pediatrics Staff – thank you all!
- Staff is always very helpful and Dr. Meghan Weir has been great with our daughter since she was a newborn. Have recommended both Dr. Weir and Garden City to others.
North Shore Pediatrics, Danvers – 480 Maple Street
- North Shore Pediatrics and Dr. David Danis are an absolute FAVORITE. We cannot speak highly enough of Dr. Danis!!
- Dr. Lance Goodman is an amazing doctor. We all think he does a great job and is very compassionate, understanding and knowledgeable.
PRACTICE RECOGNITION
The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local, meet our quality targets and support their colleagues.
This month’s winners are:
James Rowe, MA, Blackburn Primary Care Gloucester was recognized for his comment “James is also very good – very professional and is a calming influence.”
Jane Sheridan, Cape Ann Eye Specialists, Gloucester received a Teamwork award for collaborating with NEPHO Quality team to improve care for patients.
Please let us know if you would like to nominate a team member in your practice or another practice for the recognition program.
We will deliver gift cards to the winners each month, and they will be announced here in the newsletter. Please be sure to look for the new winners in next month’s issue!