2023 PriorityMedicare D-SNP Model of Care training is due Dec. 31
Who needs to complete training?
All providers who are part of the Priority Health Medicare Advantage network need to complete training. This includes specialists, ancillary providers, or anyone part of an ICT (interdisciplinary care team) for a D-SNP member. This is a CMS requirement.
How do providers complete the training?
Providers can complete our training using one of two options.
Option #1: Bulk attestations
You can group our D-SNP MOC training with existing, required training (like compliance training) so you can submit attestation for providers at the same time. If this option is selected, you’ll need to:
Distribute training to your providers using this link.
To attest to training, you must fill out the roster template with providers who’ve received training. If you choose to submit a provider roster, only the Priority Health MOC roster Excel sheet provided will be accepted.
Send attestation rosters to DSNPtraining@priorityhealth.com.
Option #2: Virtual training (only takes 15 minutes)
Training is available as an on-demand webinar and only takes 15 minutes for providers to complete. Online training can be accessed here. Provider registration for the on-demand webinar counts as attestation, which means no additional documentation is required.
Be sure to submit the correct provider NPI
Ensure the correct provider NPI number is included when submitting the provider roster or registering for the online training. If the NPI is incorrect, the provider’s status will be marked "incomplete" in our system. To correct an "incomplete" status due to an incorrect NPI, resubmit the provider roster or re-register for the online training with the correct provider NPI.
Your Provider Strategy & Solutions consultant will send you a report with providers who still need to complete training.
An important update regarding transplant services and CAR T-cell and gene therapies
Effective Mar. 1, 2024, all bone marrow transplants, organ transplants and CAR T-cell and gene therapy for Priority Health commercial members will be managed through the Emerging Therapy Solutions (ETS) network. This change doesn't include Medicare and Medicaid.
To ensure a seamless transition, ACNs that provide transplant services and CAR T-cell and gene therapies are encouraged to finalize an agreement with ETS before Mar. 1, 2024.
Why are we making this change?
Priority Health is a nonprofit health plan with low administrative costs that spends nearly 90 cents of every dollar on our members. Transplants, CAR T-cell, and gene therapies are specialized and constantly changing. That's why we're partnering with an industry leader—ETS—to ensure our members get the care they need.
Who is ETS?
ETS’s mission is to help its patients across the nation get the treatment they need for rare and complex conditions through bone marrow transplants, organ transplants, and cell and gene therapies.
Is the prior authorization process changing for transplants or CAR T-cell or gene therapy?
No. For transplants, please continue to fill out the appropriate prior authorization form (available for download on our provider manual) and either attach it to your submission in the GuidingCare portal or submit it via fax, to the number indicated on the form. CAR T-cell and gene therapy prior authorization requests should continue to be submitted via the Surescripts portal.
You’ll continue to work with Priority Health directly for claims and billing.
What are the next steps for ACNs that provide transplant services and CAR T-cell and gene therapies?
If you don’t already have a contract with ETS, they have reached out to your organization.
What happens if you don’t have a contract with ETS by Mar. 1, 2024?
For providers not contracted with ETS by Mar. 1, 2024, ETS will perform Single Case Agreement (SCA) negotiations for services rendered by a non-contracted facility or provider. SCAs will not affect member benefits or the amount the member is responsible for.
Where can I reach ETS if I have questions, or if I need to secure a participation agreement?