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Clinically Integrated Network Newsletter
September 7, 2023
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You're invited to MSHP Provider Clinical Education Events | |
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Register for MSHP clinical events in September! Learn from the best in chronic disease management on how to implement new clinical approaches to care for your patients living with complex CKD and diabetes, obesity and suicidality.
Your attendance will count towards earning CME credit (physicians only, when applicable) and/or 2023 Clinical Integration Program Engagement credit.
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Caring for Patients with Chronic CKD and Diabetes? | | |
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Learn best practices to manage and improve clinical outcomes for people living with chronic CKD and diabetes at this CME event. Attendees will participate in an interactive, Mount Sinai clinician expert-led and case-based discussion of management considerations, best practices and when to refer to specialty care. | | |
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Caring for Patients with Complex Chronic Disease: Key Components and Updates to Diabetes & CKD Management
September 12, 2023 | 6 - 7:30 pm | via Zoom
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Hear from an Obesity Management Expert | | |
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Join your fellow MSHP clinician colleagues at the upcoming MSHP Town Hall Gathering and gain practical strategies to treat your patients with obesity. At this meeting, Dr. Elisa Bocchieri-Bustros, an expert on obesity management, will discuss new approaches in obesity treatment to implement in your practice and improve your patient’s overall health. You'll also receive updates on CI Program Quality Performance and Payer Contracting. | | |
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MSHP Town Hall Gathering
September 19, 2023 | 6:00 - 7:15 pm | via Zoom
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Inside 988: A Conversation with SAMSHA Leaders | | |
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September is National Suicide Prevention Month. We are thrilled to welcome James Wright, LCSW, Chief of Crisis Center Operations for the 988 team, Robyn Filler, LPC, Manager of Clinical Standards for Vibrant Emotional Health, and Eva Korolishin, Senior Manager for 988 Center Engagement Vibrant Emotional Health to our next Mind Matters Meeting. | | |
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MSHP Mind Matters ECHO
September 21, 2023 | 5:30 - 7:00 pm | via Zoom
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MSHP Board of Managers: Nominations Open Soon!
The Mount Sinai Health Partners Board of Managers election will be taking place in Fall 2023 and you can be a part of it! Community-based providers in our CIN are eligible for the following open seats:
- Manhattan PCP
- Non-Manhattan PCP
- Manhattan Specialist
- Non-Manhattan Specialist
There is also one open seat for employed downtown Manhattan providers of any specialty.
The nomination period will take place from September 12 – October 3.
Check your inbox in mid-September for more information on the nomination process. If you have any questions, please reach out to Lauren Hertan, Project Coordinator at Lauren.Hertan@mountsinai.org or 646-906-2416.
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Chronic Condition Management | |
Consider prescribing Angiotensin Receptor Neprilysin Inhibitors (ARNIs) in patients with heart failure | |
The AHA recommends starting patients with HFrEF on ARNIs as a first line of treatment and should also be considered for HFmrEF and HFpEF patients, when clinically appropriate. | |
- Before initiating ARNIs, stop any ARB and ACEI medications. For patients on ACEI, allow a 36 hour washout period to reduce the risk of angioedema.
- Convert to the appropriate ARNI dose according to the previous ARB or ACEI dose. For patients not previously on ACEI or ARB, start at the lowest dose sacubitril 24 mg/valsartan 26 mg twice per day
- Double the dose every 2 to 4 weeks as tolerated, up to a target dose of sacubitril 97 mg/valsartan 103 mg twice per day. Monitor blood pressure, electrolytes, and renal function during titration.
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Use cautiously if eGFR <30 mL/minute/1.73 m2
Note: The use of ARNIs as first line agents applies to patients with HFrEF. For patients with co-existing HTN and HFpEF, first line agents can be ACEi or ARB.
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ICD-10-CM Code Updates
CMS released the ICD-10-CM code updates for FY 2024, which go into effect October 1, 2023. The American Academy of Professional Coders (AAPC) prepared an overview of changes you should be aware of.
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Aetna's New Prior Authorization for GLP-1 Agonists
Due to the trend of off-label use of GLP-1 agonsists for weight loss, Aetna is implementing a new prior authorization requirement for certain formularies for patients without an indication of type 2 diabetes. This policy will take effect September 1, 2023.
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Cigna Medicare Advantage Appeals
Cigna Healthcare strives to informally resolve Medicare Advantage issues raised by providers on initial contact whenever possible. If an issue cannot be resolved informally, Cigna Healthcare offers an appeals process for resolving contractual disputes regarding preservice and post-service payment denials. This process is outlined in the 2023 Medicare Advantage Participating Provider Manual.
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Cigna Precertification Update
Cigna recently announced the removal of nearly 25 percent of medical services that require precertification, affecting Commercial and Individual & Family Plan (IFP) customers.
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View the complete list of services that require precertification of coverage for U.S. commercial and IFP customers by logging in to the Cigna for Health Care Professionals website (CignaforHCP.com) > Resources > Precertification > Medical > Complete List of Services
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Complete the Cigna Special Needs Plan Model of Care Training
The 2023 Special Needs Plan (SNP) Model of Care training is now available to Cigna Medicare Advantage providers. All providers who see Medicare Advantage patients must complete this 10-minute training by December 31, 2023 to better understand the types of SNPs and how they help the special needs population. This training is required by the Centers for Medicare & Medicaid Services (CMS).
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Providers who contracted with Cigna Medicare Advantage in 2023, click here.
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Providers who contracted with Cigna Medicare Advantage prior to 2023, click here.
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Cigna Q3 Network News
Cigna released their Q3 Network News which includes preventive care policy updates, including COVID-19 immunization codes, precertification updates, and digital ID cards.
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New EmblemHealth Policy for Billing Vendors
Starting October 1, 2023, EmblemHealth is requiring billing vendors to use their provider portal first when conducting day-to-day business and resolving issues.
If a response is not received for the issue within two business days, EmblemHealth recommends calling Provider Customer Service and providing the Message ID from their provider portal inquiry to be transferred to a live representative.
Please make sure your billing company properly sets up their staff with Billing Specialist portal accounts for your Tax ID(s). Please refer to the
EmblemHealth Provider Portal Training for help.
In the coming months, Emblem will also offer live agent chat on their provider portal. This feature will allow you to ask real-time questions with an agent, improving your own and your billing company’s experience with the portal.
Learn more
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EmblemHealth August 2023 Provider Newsletter
EmblemHealth released their August provider newsletter. Highlights include:
- New surgical, sleep study, and DME preauthorization request templates on the provider portal, building on previous enhancements that enable faster care decisions
- Annual mandatory reporting and training, including Wage Parity Compliance attestations, Special Needs Model of Care Training (SNPMOC), and training for facilities that serve members currently under the care of a Voluntary Foster Care Agency.
- Updates to Timely Filing Limits, the Laboratory Benefit Management program through Avalon Healthcare Solutions, and guidance for providers caring for older members
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UnitedHealthcare Policy Updates
Please review the latest policy updates from United, including:
- Removal of prior authorization requirement for many procedure codes beginning September 1
- Drug & formulary list update
- Preventative care services guidelines (including breast imaging and colonoscopy)
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Complete Your Q3 CI Program Requirements by September 30
Practice Communication Requirement
If you haven’t done so already, please complete the mandatory Practice Communication requirement for the 2023 Clinical Integration Program by September 30. Log on now to update your practice’s demographic information on the MSHP Practice Profile.
HIPAA Privacy Training
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Be sure to stay on top of your CI Program requirements! Download the checklist by logging into the MSHP Provider Portal and clicking on “Clinical Integration.” | |
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Keep Care in Network with Our Provider Search Tool
Use our Provider Search tool to find referrals for your patients within the Clinically Integrated Network. Search by zip code or name and filter by specialty and/or health plan. You can also prepare a directory by county, specialty, or payer.
To learn more about how to use Provider Search, watch this brief video or review this quick guide.
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Welcome to MSHP!
We'd like to extend a warm welcome to the newest members of our Clinically Integrated Network:
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Primary Care
Kamica Lewis, DO
Family Medicine
Parsley Health PLLC
New York, NY
Nicole Mann, MD
Pediatrics
Westside Pediatrics PC
New York, NY
Walt Sargeant, MD
Internal Medicine
Upper West Side Medical Associates, PC
New York, NY
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Advanced Care Practitioners
Elyssa Drucker, PA
Bobby Buka MD, PC
New York, NY
Jennifer Kahan, PA
David A. Turner Medical PLLC
Cedarhurst, NY
Denisse Serrano, PA
Bruce E. Katz, MD DBA JUVA Skin & Laser Center
New York, NY
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Specialty Care
Albert Ayoub, MD
Obstetrics & Gynecology
Goncharov Medical PC
New York, NY
Mary Galloy, AUD
Audiology
ENT and Allergy Associates
Brooklyn, NY
Simi Gupta, MD
Obstetrics & Gynecology
Lower Manhattan Medical Care PC
Brooklyn, NY
Nicole Lee, MD
Dermatology
Epoch Dermatology
Garden City, NY
Devan Marshall, AUD
Audiology
ENT and Allergy Associates
Parsippany, NJ
Lazar Popilevsky, MD
Anesthesiology
Goncharov Medical PC
New York, NY
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If you have any questions about any of our announcements, please contact your Population Health Manager, email Mount Sinai Health Partners at mshp@mountsinai.org or call us at 877-234-6667.
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P: 877-234-6667
F: 646-537-1481
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