Quarter 1 - Arizona Priority Care

Pulse
Physician Newsletter
Physician Spotlight:
Effective 1/1/2015
Dr. Amish Purohit: AZPC’s
Chief Medical Officer
looks ahead to 2015
A
s 2015 begins to unfold,
Arizona Priority Care looks forward
to another year of unprecedented
growth, not only in our member
base, but with the physician
network as well. In just under four
years, we have seen our member
base triple. In addition, the
physician network has more than
exceeded the patient growth.
Consequently, changes to our
processes and procedures are based
on the input we receive from the
physicians in the network. Physician
engagement serves as a critical
factor in our success.
We are hosting small quarterly
dinners with our providers in each
of our regions. We want to hear
from our physicians, acknowledge
their concerns and address those
needs in a timely fashion. We have
a dedicated provider relations team
to address your needs on a regular
basis. In addition, we have built a
team in our HCC/STARS Department
as a resource for our providers that
includes specialized coders and
physician liaisons to assist your staff
and physicians to meet and review
the program with you.
February 2015
Health Net has two physician
networks in Maricopa County:
Dr. Amish Purohit, AZPC Chief Medical Officer
We’ve Moved!
New corporate address:
585 N. Juniper Dr., Ste. 200
Chandler, AZ 85226

Arizona Priority Care Network

Banner Network
Note: The Health Net Direct
Network has been eliminated in
Maricopa County.
AZPC members must use a
specialist within the AZPC
network or the PCP must request
a prior authorization.
Reminders
The HCC and STARS programs carry
incentive-based goals for our
providers that practice the HCC
models for acceptable coding and
documentation of diseases.
Verification of eligibility
is critical.
Always verify eligibility with
Health Net for PCP assignment at
1-800-977-7192.
Additionally, we have listened to
your concerns regarding the
authorization and referral process
and are working diligently at
streamlining these efforts to provide
you with quicker response times.
AZPC’s exclusive
lab provider is
Sonora Quest.
If you need lab requisitions for
Sonora Quest, contact your
Sonora Quest Representative.
We extend our thanks to you for
being partners in our mission to
ensure quality health care and
outcomes. We greatly appreciate
your dedication in managing our
mutual patients. Thank you for your
continued support.
Customer Service
PROVIDERS:
480-499-8720
MEMBERS:
480-499-8750
Changes in 2015
The Referral and Authorization Process
Community Spotlight
AZPC GIVES BACK
A referral must be on file to expedite the
claims process.
Initial referral includes:

One initial consultation

Two follow up visits
Any additional follow up visits and/or
procedures will require submission of prior
authorization request(s) before services being
rendered.
To submit a request for a referral or
authorization:
Complete the Referral form and/or Prior
Authorization form.
Fax in the Referral/Prior Authorization form to
480-499-8798.
Claims Tip
Submit your claims for AZPC patients
directly to our claims department, not
Health Net. When claims are submitted to
both, we must verify that it is a duplicate.
This verification delays the payment
process.
Find It On Our Website
Find 2015 Claims Updates in the Providers
tab of our website at
http://www.azprioritycare.com/providers
Arizona Priority Care employees make time to make
a difference in the community. Here’s a recap of our
efforts in 2014.
Salvation Army Bottled Water Drive (June) Collected
6 pallets of water & $315 – their largest water
donation!
Alzheimer’s Association The Longest Day (June)
Sponsors of "The Longest Day" and raised $3,000.
The Lion’s Club Lions Sight & Hearing Foundation
(August) Donated 84 pairs of eye glasses.
Children First Academy of Tempe (August) Box Tops
for Education collection - Collected 177 Box Tops.
American Diabetes Association Walk to Stop
Diabetes (October) Raised $7,055.
Justa Center (November) Donated 350 toiletries.
United Food Bank (December) Collected 1,121 food
items, plus $1,520.
Adopt-A-Family (December) Donated food, clothing,
bedding, and household items to a family in need.
Save the Date
Submit Your News
Join us for Arizona Priority
Care’s First Annual Spring
Shootout April 25, 2015 at the
Legacy Golf Resort.
What’s going on at your
practice?
This golf tournament is open
to physicians in the Arizona
Priority Care Network only.
Registration is at 6:30 a.m.
We would like to invite you to
share any news, events, press
releases and photos, and we’ll
share it on our website, newsletters, social media
sites or other marketing materials.
Look for more details soon.
For more information, call
480-499-8700 ext. 8232.
Have a story you want to tell?
Send your news and updates to
[email protected] or call
(480) 499-8700 x8233.
PULSE QUARTERLY ISSUE 1 www.azprioritycare.com
Focus for 2015: Annual Wellness Visits
It is recommended that you order labs before the
AWV so they can be reviewed during the face-toface visit. Suggested lab panel includes: CBC, CMP,
HbA1C, lipids, B12/folate, Vit D, microalbumin and
others as needed.
You may use our form or your own EMR template
as long as it is approved by the HCC/STARS team
first. Remember the components of the AWV, as
required by CMS, are:
 Medical, surgical, family, social, allergy history
 Medication listed and reviewed by provider
 Functional status including: ADL’s, cognitive
evaluation & screening for vision, hearing and
speech problems
 Depression screen
 Pain screen or treatment plan if pain present
 Vital signs including BMI
 A list of specialists and DME suppliers
 An assessment of ALL CHRONIC medical
conditions with a status and plan for each.
AZPC pays an incentive for every AWV completed
and validated.
Attention PCPs:
Are you participating in our ACO Network?
1) Focus: non-HMO patients
2) Goal: Improved coordination of care for
non-HMO patients
3) AZPC-ACO is a separate entity and
requires a separate contract.
Contact us at [email protected]
for more details.
Ineke Ayubi-Moak, MD
Mujtaba Shafiq, MD
Our HCC physician liaisons can assist you with
issues related to HCC and STARS.
Why are CPTII Codes Important?
This year, CMS plans to decrease Medicare
payment on claims by 1.5% based on 2013
performance, and plans additional payment
decreases after 2015. Special rules apply to
the use of CPT II codes for the Medicare PQRS
(formerly PQRI) bonus program. See the CMS
website for details.
AZPC also pays an incentive on STAR
measures and this would be a great way to
ensure all the measures are being reported to
us. We have a CPTII Tip Sheet on our
website at www.azprioritycare.com or call us
with questions at 480-499-8764.
Mark Your Calendars
Quality/HCC/STARS
University Schedule
February 21
March 28
April 18
May 16
Annual attendance at one of the above sessions is
mandatory to be eligible for the bonus.
PULSE QUARTERLY ISSUE 1 www.azprioritycare.com