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Help members get vaccinated and find care during COVID, flu and RSV season

Between August 13 and August 19, 2023, hospital admissions in the U.S. linked to COVID-19 increased by almost 19%, as reported by the Centers for Disease Control and Prevention (CDC). With the current COVID-19 uptick and the approaching flu and respiratory syncytial virus (RSV) season, providers play a key role in educating patients, parents and caregivers about the importance of vaccination and where to go for care.

Remind your patients about the best ways to avoid getting sick

Vaccines and immunizations are the most effective ways to prevent one of these viruses. Individuals can get more than one vaccination at the same time.

An annual flu vaccine is recommended for everyone 6 months or older.

The updated COVID-19 booster is expected to be more effective against the current strains circulating in the U.S. Members can receive the new COVID-19 booster at a pharmacy or through their provider.

RSV vaccines are available for those 60 and older. Also, an RSV vaccine is available for pregnant people, so antibodies can be passed to babies before they’re born. Two monoclonal antibody products are also available for the prevention of RSV in select infants, Synagis and the newly available Beyfortus. The CDC recommends:

  • Abrysvo and Arexvy for those 60 and older using shared decision making.
  • Abrysvo for pregnant persons during 32 to 36 weeks of pregnancy.
  • Beyfortus for all infants younger than 8 months born during or entering their first RSV season (typically fall through spring) and infants 8 to 19 months who are at increased risk of severe RSV disease and entering their second RSV season.

Note: Effective for dates of service on or after September 1, 2023:

  • For commercial members, Abrysvo, Arexvy and Beyfortus are covered at no cost for members.
  • For Medicare members, the RSV vaccine is covered at no cost for members with Part D coverage. The vaccine will not be covered for those members with only medical (Medicare Parts A or B) coverage.

In addition to encouraging your patients to get vaccinated, remind them to cover their coughs and sneezes, stay away from people who are sick, stay home if they’re sick, wash hands often, and improve air circulation in the home and workplace. The CDC also recommends wearing a KN-95 mask in public for people who have symptoms of respiratory illness, are immunocompromised or at increased risk of severe disease, or are in an area where the risk of transmission is high, such as on public transportation.

If they do get sick, Asuris members have alternatives to emergency departments (EDs) that many have found to be faster, more convenient and less expensive.

Remind patients how they can contact you to receive care, and advise them about their care options, which include:

  • Virtual care: If you offer telehealth services, as many of our providers do, remind patients how they can schedule an appointment that will take place without them having to leave their home. Most of our members also have access to telehealth vendors that offer convenient appointment times.
  • At-home care: DispatchHealth can provide in-home, same-day medical care to your patients for urgent illnesses, such as respiratory viruses, and injuries. DispatchHealth is available in the Spokane area.
  • Urgent care clinics: Many urgent care clinics are conveniently located and more accessible than EDs.

Learn more about our members’ convenient care options in our Care Options Toolkit.

Help your patients know their options before they need care

  • Encourage your patients to sign in to asuris.com and use the Find a Doctor tool to locate care options near them so they know where to go when they need care.

We’re here to help

Members can call the Customer Service number on the back of their member ID card for help finding in-network providers and pharmacies and understanding their care options.

9/21/2023 Updated

Asuris EquaPathRx program

As a reminder, we are launching Asuris EquaPathRx January 1, 2024, as a provider-administered specialty medication benefit for specific drugs with a provider network solution that keeps the provider-patient relationship intact and the costs of care predictable for members.

We appreciate the feedback we have received about the administrative burden of submitting the claim for medical services to us and for the medication to Prime Therapeutics. We have identified a solution that eliminates that burden and will not require you to submit separate claims. With this solution, you will continue to submit claims directly to us as you do today, and we will adjudicate the medication portion of the claim in accordance with the terms and rates of the agreement you have with Prime Therapeutics for the IntegratedRx® - Medical network. This agreement supersedes the terms and rates applicable to those medications under your agreement with us.

Note: You must have a contract with Prime Therapeutics to be reimbursed for administering medications included in the Asuris EquaPathRx program to members with the new benefit.

Please contact Prime Therapeutics to complete the process of credentialing and contracting for the IntegratedRx - Medical network. To ensure that you’re added to the network by January 1, 2024, complete the credentialing and contracting process with Prime Therapeutics before October 31, 2023.

Learn more about the Asuris EquaPathRx program.


New pre-authorization requirements for select Individual commercial members

Effective November 1, 2023, new pre-authorization requirements will apply for nutrition therapy and hysterectomy for select Individual commercial members. Additionally, three new codes will be subject to post-service review for air ambulance transport for these same members.

Please continue to use the Electronic Authorization application on Availity Essentials to determine whether a pre-authorization is required and submit the request.

Read the August issue of our provider newsletter or view our commercial pre-authorization list for details.


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