1. The Michigan Primary Care Transformation (MiPCT) Project
Addition of Priority Health to MiPCT: An Overview and Your Questions Answered!

2. Agenda Welcome and Overview of Priority Health’s Addition
MiPCT Touchpoints for Priority’s Inclusion
Dashboard and Member List implications
Care Management (staffing, etc.) implications
Priority Health: The Specifics!
Lines of business included
Billing guidelines
Etc
Q and A

3. Overview: Priority Health Addition
Adds approximately 150,000 members
All Priority MiPCT eligibles will be in fully-insured Priority POS, PPO and HMO products
Reimbursement for care management services builds other commercial payers
Allowing first dollar coverage (without patient financial obligation for satisfying a deductible) for care management services delivered to high deductible plan members with Health Savings Accounts.

4. Member List and Dashboard Implications
Fully insured HMO and POS members to be included on MiPCT multipayer member lists in August
MiPCT eligible PPO members to follow (interim solution discussed later in webinar)
Priority members to be included on dashboard after historical claims data are available and processed (December 2013)

5. Care Management Implications
No change immediately in Care Management staffing sufficiency requirements
Staffing needs to be revisited at beginning of to determine if existing staff are sufficient to service the needs of patients

6. Priority Health: The Specifics
Laura Stuursma (Lead of Priority Implementation Team)
G-codes
CPT-codes
Covered membership

7. Priority Health G-codes
Interpretation and documentation
Coverage
Reimbursement
Unique payment process

8. Priority Health CPT codes
Interpretation and documentation
Coverage
Reimbursement
Claims payment and processing

9. Priority Health membership
G-codes – MiPCT practices only (FF-HMO, FF-POS and FF-PPO)
CPT codes
TCM codes covered by Medicare and Medicaid plans
Payable to all network practices
Benefit coverage for any member in applicable plans
Members do not need to be assigned or attributed to the practice
Members do not need to be included in a MiPCT monthly list

10. Q and A