Connection supplemental articles and policies - May 2008

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Connection - May 2008 (pdf, 295 KB)

supplemental articles

• Get free patient safety alerts
• Commercial plan formulary updates

policies and forms

The following policy is new:

• Dermatology payment policy

The following policies have been reviewed and have substantial changes. For more details, please see “policy changes” below.

• Anesthesia payment policy
• Observation status payment policy

Get free patient safety alerts

We’d like to let you know about a new—and free—electronic service that will furnish FDA-patient safety alerts to you on an instantaneous basis. The new service promises to be a faster and more systematic way for your practice to get important alerts, including product recalls and warnings—thus improving patient safety.

This initiative, called the Health Care Notification Network (HCNN), is being launched by the iHealth Alliance and managed by Medem, a health IT firm founded by the AMA and state medical societies.

To sign up for the service, go to http://www.hcnn.net/. The service allows you to designate other staff members to receive the same online alerts. You can opt out of the service, which will be used only for patient safety notices, at any time.

Formulary updates

Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications. Please note the following changes to our commercial plan formulary.

Commercial plan formulary

Changes

New to market policy*

Intelence™ (etravirine)

* FCHP’s New to Market Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for noncovered pharmaceuticals.

Policy changes

We have made the following payment policy updates:

• Dermatology Payment Policy
  • This is a new policy for Fallon Community Health Plan.

• Observation Status Payment Policy
  • We revised this policy to include the professional component for observation stays.

• Anesthesia Payment Policy
  • We have incorporated the Obstetric Anesthesia Policy into this policy so that all guidelines related to anesthesia are in one place. The Obstetric Anesthesia Policy will be discontinued on the effective date of this Anesthesia Payment Policy.
  • We’ve updated this policy to provide billing guidelines for trigger point injections; epidural and spinal analgesia; anesthesia and discontinuous blocks of time; administration of anesthesia; and day-of, prior-to and post-surgery.
  • This policy clarifies use of: recognized modifiers; unit time calculation; and cap time for vaginal delivery.