Quality Programs - Provider News

Premera Programs Help Members Choose High Quality Providers | 11/6/2023

Learn about our Centers of Excellence and Blue Distinction Specialty Care Programs

Blood Pressure Coding Can Reduce HEDIS® Medical Record Requests | 10/5/2023

Add CPT^® II codes to patient claims to close gaps in care for patients

Remind Your Eligible Patients to get Regular Mammograms | 10/5/2023

Regular screenings lead to better outcomes

September Care Gap Member Outreach | 9/7/2023

Members may receive mailings on cancer screening and chronic conditions reminders

Well-Child Member Outreach | 8/3/2023

Premera will continue to send communications about the importance of well-child checkups

Chronic Condition Member Outreach | 8/3/2023

This summer, members will receive communications about monitoring their asthma and diabetic HA1c testing

Talk to Your Patients About Osteoporosis After Fragility Fractures | 7/6/2023

Tip sheets to learn more about the osteoporosis management in women who had a fracture (OMW) HEDIS^®, including information about exclusions and best practices

CMS Surveys MA Patients About Fall Risk, Urinary Incontinence, and Physical Activity | 7/6/2023

Discussing these common issues every year supports a positive experience for your patients

Outreach for Closing Member Care Gaps | 7/6/2023

Educating members on the importance of preventive cancer screenings and routine checkups

Engaging with Frequent Emergency Room Users | 7/6/2023

Informing members of quality care options for an urgent need vs. an emergency

Statin Therapy for Patients with Cardiovascular Disease and Diabetes | 6/1/2023

Read about how important statins are for people with diabetes

HEDIS® Measures for Diabetic Patient Health | 5/4/2023

Learn more about what is included in the measures and ways you can close gaps in care for patients with diabetes

Revised HEDIS® Measure Focuses on Helping Prevent Unnecessary Hospital Readmissions | 5/4/2023

Coordinating care from the hospital to home and ensuring a follow-up visit with the primary care physician can help your patients avoid a readmission

Well Child Checkup Outreach | 4/6/2023

Learn how we’re engaging with parents to keep children on track with well child checkups

Outreach to Close Gaps in Care for Premera Members | 4/6/2023

Members will receive personalized communication about needed cancer screenings and diabetic HA1c testing

HEDIS® is Measuring Medication Management and Care Coordination for Medicare Beneficiaries | 4/6/2023

We’re encouraging providers to enroll in an admission, discharge, and transfer alert system to ensure timely receipt of information

Follow-Up With Your Patients After an Emergency Department Visit | 4/6/2023

Learn more about the HEDIS® measure and information about eligible chronic conditions, exclusions, best practices, and documentation requirements

2022 Practitioner Survey Results: Medical and Behavioral Health Collaboration | 4/6/2023

Sharing information about the patient’s treatment plan and prescribed medications improve coordination and safety for patients accessing behavioral healthcare services

Understanding Star Ratings - What is your Role as a Provider? | 4/6/2023

Star ratings help members enhance relationships with providers and health plans by ensuring accessibility to care, enhanced quality of care and optimal customer service

Advanced Illness and Frailty Exclusions Allowed for HEDIS® Star Measures | 3/2/2023

Some patients can be excluded from select HEDIS^® star quality measures due to advanced illness and frailty – learn the criteria and codes

Helping Patients Who Use the Emergency Department for Migraines | 3/2/2023

Learn about informative migraine materials you can share with your patients

Outreach Mailings to Members with Children | 2/2/2023

Premera is reaching out to members to keep children on track with vaccines and checkups

High Blood Pressure Educational Mailing | 12/1/2022

Premera is providing members with winning tips for a healthy heart

October Care Gap Member Outreach | 10/6/2022

Outreach to members includes well-child checkups, cancer screening, reduced ED utilization, and improved care for chronic conditions

September Care Gap Member Outreach | 9/1/2022

Care gap reminders and asthma information are being sent to some members

Helping Patients Who Use the Emergency Department for Migraines | 9/1/2022

Informative Migraine Materials to Share with Your Patients

August Care Gap Member Outreach | 8/4/2022

Learn more about home test kit and well-child checkup outreach for members

Teaming Up for a Better Member Experience | 8/4/2022

Premera Quality Programs is working the providers to improve care for our members

Diabetic Retinal Eye Exam Results Form | 8/4/2022

Check out this simple tool for providers to document and share Diabetic Retinal Eye Exam (DRE) results

HEDIS® Measure: Osteoporosis Management in Women | 7/7/2022

Get tip sheets with information about medical records and ICD-10 codes needed for patient claims

Health Outcomes Survey Begins in August | 7/7/2022

To prepare for the upcoming survey, be sure to discuss fall risk, urinary incontinence, and physical activity with your Medicare patients

Annual Risk Adjustment Data Validation Audits | 7/7/2022

Provider offices may receive a request for medical records from Cognisight or directly from Premera

Well Child Informational Mailings and Growth Chart | 6/2/2022

Members in Washington and Alaska will receive mailings about well-child checkups

Statin Therapy Can Reduce Risk and Complications | 6/2/2022

Centers for Medicare & Medicaid Services measures support the importance of statin therapy to reduce risk of diabetes and atherosclerotic cardiovascular disease (ASCVD) complications

Plan All-Cause Readmissions, a Revised HEDIS® Measure | 5/5/2022

Revised measure focuses on preventing unnecessary hospital readmissions

Care Gap Member Outreach | 5/5/2022

Members will be receiving cancer screening, diabetes, asthma, and preventive care communications

HEDIS Measure: Colorectal Cancer Screening | 2/25/2022

Encourage eligible Medicare Advantage patients to get screened for colorectal cancer

Advanced Illness and Frailty Exclusions Allowed for HEDIS® Star Measures | 2/25/2022

Encourage eligible Medicare Advantage patients to get screened for colorectal cancer

Medical and Behavioral Health Collaboration: 2021 Practitioner Survey Results | 2/24/2022

Sharing information about the patient’s treatment plan and prescribed medications improve coordination and safety for patients accessing behavioral healthcare services

Improving the Patient Experience | 2/3/2022

Gain insights from Consumer Assessment of Healthcare Providers and Systems research

HEDIS® Quality Measure Changes in 2022 | 2/3/2022

Learn about the impacts for star ratings

Outreach for Well Child Checkups Continues in December | 12/2/2021

Well-child visits are crucial to children receiving timely care and vaccines

Premera Programs Help Members Choose High Quality Providers | 11/18/2021

Learn about our Centers of Excellence and Blue Distinction Specialty Care Programs

Care Gap Member Outreach | 10/21/2021

Member communications sent about cancer screenings, care for chronic conditions, and well-child checkups.

Medical Records Requests | 10/21/2021

This fall, your office may receive medical record requests from Change Healthcare and Cotiviti.

Fall Care Gap Member Outreach | 10/8/2021

Results from the provider survey on the collaboration of primary care and behavioral health practitioners

2020 Practitioner Survey: Medical and Behavioral Health Collaboration | 9/16/2021

Results from the provider survey on the collaboration of primary care and behavioral health practitioners

Member Outreach Addressing Care Gaps | 8/19/2021

Premera is reaching out regarding care gaps in diabetes, emergency department utilization, and colorectal cancer screenings

In-Home Health Screening Kits for Medicare Advantage Members | 8/5/2021

Premera will send in-home health screening kits for members with care gaps

When is a Condition Historical vs. Active? | 7/1/2021

Learn how key words and phrases within the provider’s documentation can reveal whether a condition is historical or active.

Care Gap Outreach for Federal Employee Members | 7/1/2021

Cancer Screenings and Diabetic HbA1c Testing

Introducing the Premera Premier Provider program | 6/3/2021

Recognizing providers for high quality and cost-efficient care

HEDIS Measure: Comprehensive Diabetes Care | 5/6/2021

Improve patient outcomes while reducing medical records review requests

Diagnosis Coding for Immuno-compromise | 5/6/2021

A common error in coding is not considering whether the condition is caused by medication or by an underlying chronic condition

HEDIS Measure: Controlling High Blood Pressure | 4/9/2021

Blood pressure coding can reduce HEDIS^®medical record requests

Enhanced Care for Out-of-Area Blue Plan Members | 4/1/2021

Premera is working with providers to increase care quality by making sure members can get appropriate care no matter where they are.

Coagulopathy: Medication-induced or Systemic? | 4/1/2021

How to submit diagnosis codes for patients on anti-coagulant medication therapy.

Virtual Care Benefits Extended | 3/18/2021

Premera is a covering applied behavioral analysis in a virtual setting until December 31, 2021.

HEDIS Measure: Medication Reconciliation Post-Discharge | 3/18/2021

Medication reconciliation post-discharge is critical to patient safety and care coordination efforts.

Annual HEDIS® Medical Review | 3/18/2021

This spring you may be contacted by COTIVITI to request medical records.

Improve HEDIS® Scores through Claims Coding | 2/18/2021

Reduce the need for medical record reviews and improve HEDIS scores.

Tips for Improving the Patient Experience | 2/18/2021

Gain insights from CAHPS research.

Upcoming Medical Record Request | 11/5/2020

Plan for risk adjustment and HEDIS medical record requests coming this winter.

Well-Baby Checkups: Parent/Guardian Education | 10/1/2020

We’re taking a new approach to educating parents/guardians on the recommended checkup and vaccine schedule.

Helping Members with Asthma Manage Their Condition | 10/1/2020

Premera is sending an educational mailer to help members with asthma.

A New Approach to Engaging Members with Multiple Care Gap | 9/17/2020

Members will receive scorecards for their open and closed care gaps.

Home Test Kits for Members in Alaska and Washington | 9/17/2020

Annual FIT and HbA1c home test kit program launches in mid-September.

Diabetic Retinal Eye Exam Educational Outreach | 8/6/2020

Information about diabetic retinopathy screening will be sent to select Medicare Advantage members.

Home Test Kits During COVID-19 Pandemic | 7/2/2020

Members can complete important health tests at home.