Mandatory Action for Prism Security Administrators: Annual pSA Renewal Process
Our annual prism Security Administrator (pSA) renewal period is underway. pSAs will have until Aug. 1 to review and either approve or deny all user affiliations for your group or facility. 

What exactly is happening?
Each provider group and/or facility needs a pSA to control access to data like claims, authorizations and appeals. pSAs control access by approving or denying affiliation requests. During this annual pSA renewal period, pSAs review affiliation requests they’ve already approved to make sure each user’s access is still needed.  

If a user’s affiliation is renewed by their pSA, nothing will change for that user. If a user’s affiliation is denied, that user will lose access to all of that group or facility’s data. If users aren’t renewed, they'll automatically be removed from the provider affiliation after Aug. 1. It’s important for pSAs to review all renewals and take action to ensure access isn’t disrupted.  

Important: Even if you have already checked your pSA renewal assignments, check again as additional users may have recently been added for review.

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We're Reprocessing 2025 CRNA Claims Due to Payment Error
Since Jan. 1, 2025, Certified Registered Nurse Anesthetist (CRNA)claims have been incorrectly paid $0.

There’s nothing you need to do.

We’re updating our system configuration to support contractually appropriate payments and will reprocess impacted claims according to our Corrections to payments policy.

Reminder: You must Complete Our 15-Minute, CMS-Required D-SNP Model of Care Training by Dec. 31
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care (MOC) every year.

Our Model of Care is a quality improvement tool that ensures the unique needs of our D-SNP members are met and describes the processes and systems we use to coordinate their care.

Who needs to complete Model of Care training?

• All providers who are part of the Priority Health Medicare Advantage network. (All providers contracted with this network must complete the MOC training, regardless of whether they participate in Medicaid.)
• Out-of-network providers who see at least five D-SNP members. This includes specialists, ancillary providers, and anyone part of an ICT (interdisciplinary care team) for a D-SNP member.

This is a CMS requirement.

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Updated 2025 HEDIS Provider Reference Guide
We recently made policy changes and clarifications to the 2025 HEDIS Provider Reference Guide in alignment with the National Committee for Quality Assurance (NCQA) HEDIS MY (Measure Year) 2025 Volume 2 Technical Update.

The following measures were updated:

• Asthma Medication Ratio (AMR)
  
  • Removed albuterol-budesonide as an asthma reliever medication
  • Revised the Asthma Controller Medications table
• Controlling High Blood Pressure (CBP)
  
  • Updated the required exclusions
• Statin Therapy for Patients with Cardiovascular Disease (SPC)
  
  • Updated prescription information in the High and Moderate Intensity Statin Medications table
• Eye Exam for Patients with Diabetes (EED)
  
  • Updated required exclusions and numerator
• Statin Therapy for Patients with Diabetes (SPD)
  
  • Updated prescription information in the High and Moderate Intensity Statin Medications table
• Transitions of Care (TRC)
  
  • Revised the hybrid specification for the Notification of Inpatient Admission and Receipt of Discharge Information indicators
• Breast Cancer Screening (BSC-E)
  
  • Updated the member age range for this measure from 50-74 years of age to 40-74 years of age
• Blood Pressure Control for Patients with Hypertension (BPC-E)
  
  • Updated exclusions and numerator compliance
• Adult Immunization Status (AIS-E)
  
  • Updated the numerator criteria of the herpes zoster vaccine
• Social Need Screening and Intervention (SNS-E)
  
  • Updated the definitions for the following: Housing instability, Homelessness, and Housing inadequacy

Access the guide on the Quality Improvement page through our Provider Incentives webpage in prism (login required).

ACNs Can Still Opt Into Our Exact Sciences Colorectal Cancer Screening Campaign
Our campaign to close care gaps for the Colorectal Cancer Screening (COL-E) HEDIS measure through Exact Sciences is active and runs through the end of 2025. ACNs must opt into this campaign if they’d like colorectal cancer test kits sent to their patients with open care gaps.

What’s the Exact Sciences campaign?
We’ve partnered with Exact Sciences to send at-home colorectal cancer test kits to members across all lines of business with an open care gap for a colorectal cancer screening.

Can the Exact Sciences campaign increase my COL-E scores?
Yes. ACNs who participated in our Exact Sciences campaign in previous years were able to reach an average of 28% of targeted patients, who otherwise may not have received screenings. This helps to increase COL-E scores all well as providers’ performance in our PCP Incentive Program (PIP).

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Reminder: HMA members have access to Priority Health’s network
Priority Health launched a new product on Jan. 1, 2025, called HMA. HMA is a third-party administrator (TPA) product, but HMA plan members have access to Priority Health's PPO network.* Make sure you accept this health plan, as you would with any Priority Health plan. 

Be on the lookout for this member ID card:

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