Provider Resources

News and Announcements

March 2019

Care Continuum to Review Medical Drug Authorization May 1

In our ongoing efforts to improve prior authorization processes, we are partnering with ESI Care Continuum (CCUM) for medical drug prior authorization effective May 1, 2019.

ESI Care Continuum will handle pre-determination and prior authorization requests for medical drug (excluding oncology drug) for all lines of business, including Medicare and Health Exchange. eviCore will continue to review oncology medical drug requests.

Providers should submit medical drug requests via the ExpressPath portal at www.express-path.com. Online submissions will streamline communication and improve turnaround times for these authorizations.

Providers will also have seamless access to ExpressPath through the Network Health provider portal. The online authorization process takes less than 10 minutes to complete (on average), and the response is often immediate.

ExpressPath is available 24 hours a day, seven days a week. Users can complete the following tasks online.

  • Create new requests (eliminating the need to call or send faxes)
  • View the status of previously submitted requests
  • Complete or edit existing requests that may require additional information
  • Search for a previously submitted requests
    • Search by patient details such as member number, date of birth, etc.
  • Renew an approved request that will expire in the next 90 days

Tutorials for using the portal will be made available to providers prior to the May launch.  For additional information, please contact Network Health’s Utilization Management Department or your contract manager.

Read more in the latest issue of The Pulse

 

 

Every month, The Pulse newsletter delivers the latest industry news, claims updates, tips about programs available to you and your patients, pharmacy notifications, treatment information, code changes and more. 

Check out the latest issue of The Pulse


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January 2019

Medicare formulary change: Steroid/Beta-Adrenergic inhaler $8

For 2019, the generic for AirDuo (Fluticasone/Salmeterol) will now be available at an $8 cost to members for one inhaler. The member’s $260 or $395 deductible also doesn't’t need to be satisfied if the member receives this generic (Fluticasone/Salmeterol) versus Advair, Breo Ellipta, Dulera or Symbicort.

The generic version of the inhaler not only offers significant savings to the member, but it also might increase compliance with using the inhaler as prescribed.

Read more in the latest issue of The Script

The Script is the quarterly newsletter produced by the Network Health pharmacy department to inform providers of current and upcoming pharmacy-related news.

Check out the latest issue of The Script

Script Newsletter Archives

January 2019


Network Health
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