Coverage Requirement Changes for Provider-Administered Specialty Infusions
Effective October 1, 2019, Prominence Health Plan and CDS Group Health will require additional justification for medical necessity for infusion therapies of select drugs performed at outpatient hospital settings.
Elimination of PCP referral requirement
Effective immediately, Prominence has terminated the referral requirement for our Medicare Advantage members. In support of this change, we will reprocess all claims that may have received a denial for no referral on file.
Pharmacy and Therapeutic Updates
Recent changes made by the Prominence Health Plan Pharmacy & Therapeutics Committee during the quarterly review. Formulary changes are effective April 1, 2018.
New Opioid Policy
Prominence Health Plan is focused on combating the growing problem of prescription opioids. With recent changes to the State’s opioid prescribing law effective in 2018, Prominence Health Plan’s clinical staff will ensure internal coverage policies are consistent with this law.
Commercial Provider Payments
New electronic claims system through Zelis is easy, fast and secure, offering the latest in secure ePayment technology to accelerate and add efficiency to the claims payment process.