When patients, providers, and health insurance companies work together, we can create happier, healthier communities. CDPHP values the partnership we have with you and wants to ensure you have the resources you need to get your job done. From easy access to patient benefit and claims information through the provider portal to in-office visits from our provider relations team, CDPHP is committed to working with you.
Chances are the health care landscape today looks much different than when you started your career: regulations are implemented and then change, quality measures evolve and shift, and patients face an increasingly complicated and costly system. We’re committed to keeping you up to date with news you need to know. Visit here often for the information and resources you need to stay current on the local health care landscape.
New York state requires CDPHP, as a Medicaid Managed Care plan, to implement a Children’s Behavioral Health Pharmacy Program that includes the monitoring and oversight of key medications for children. Effective February 1, 2020, prior authorization will be required for:
Quarterly, Capital District Physicians’ Health Plan, Inc. (CDPHP®) implements appropriate code auditing changes to remain current with industry standard coding updates. Updates are made to our code auditing software Change Healthcare Technologies, LLC ClaimsXten™ based on recommendations from a variety of sources, including the American Medical Association (AMA), Centers for Medicaid and Medicare Services (CMS) Correct Coding Initiative and Medically Unlikely Edits, input from specialty organizations, the CPT® manual, and the HCPCS Level II manual.
CDPHP® has partnered with Canary Health to provide Virtual Lifestyle Management (VLM)* – a digital, year-long, lifestyle change program. Nationwide, more than 84 million adults have prediabetes, but 90 percent of them are unaware that they do. VLM is a Centers for Disease Control and Prevention-recognized diabetes prevention program that focuses on healthy eating and physical activity. Studies show that people with prediabetes who take part in such a structured lifestyle change strategy can cut their risk of developing type 2 diabetes by 58 percent.
On an annual basis, CDPHP assesses member satisfaction with their health care providers and our health plan using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Health Effectiveness Data and Information Set (HEDIS®) surveys. Members rate their satisfaction with various aspects of health care, including their health plan, overall health care, primary and specialty care, provider communication, shared decision making, health promotion, coordination of care, and access to care. At CDPHP, we use the results to enhance members’ care experience by building on our strengths and making necessary changes to address any areas that could be improved.
In a move designed to relieve some of the administrative burdens experienced by medical practices within our network, CDPHP is removing the requirement for prior authorization for the following services and procedures, effective January 1, 2020:
Quarterly, Capital District Physicians’ Health Plan, Inc. (CDPHP®) implements appropriate code-auditing changes to remain current with industry standards. Updates are made to our code-auditing software, Change Healthcare Technologies, LLC ClaimsXten™, based on recommendations from a variety of sources, including the American Medical Association (AMA), Centers for Medicaid and Medicare Services (CMS) Correct Coding Initiative and Medically Unlikely Edits, input from specialty organizations, the CPT® manual, and the HCPCS Level II coding system.