2025 May Network Connection

Starting May 2025: (1) Billing team must track and properly bill home-based screening test kits (HbA1c, eGFR, uACR, creatinine, Cologuard) when ordered by providers for eligible members—ensure lab results are captured in member and provider records. (2) Update encounter documentation templates to improve capture rates for: advance directives (currently 26.5% documented), immunization status (74.6% for other network providers), asthma triggers (30%), and cardiovascular risk assessments (76.4%). (3) Providers must document all diabetes-related preventive care including annual eye exams, neuropathy screening, and lipid testing to support HEDIS measures. (4) Front desk and clinical staff should familiarize themselves with new Ouma Health maternity telehealth referral pathway (ouma.me/phs) and virtual dermatology availability to streamline patient scheduling. (5) Ensure billing system captures telehealth modifier codes for virtual dermatology visits (typically -95 for synchronous telemedicine) and OB telehealth visits to properly bill $0 copay arrangements for Medicaid/Medicare and most Commercial plans. Failure to properly document and code preventive services will result in missed reimbursement opportunities and lower quality metric performance in future audits.