The Point Issue 2 2019

Faxing Medical Records Reminder

The Martin’s Point Provider Inquiry team does not handle medical records. Please do not fax medical records to 207-253-6233. To avoid misdirected medical records, be sure you are using the appropriate fax number. For more information about departmental fax numbers, please refer to the Contact Us page on the Provider Portal.

Biosimilars Are on the Rise: FAQs

With a surge in FDA-approved biosimilars in 2018, and at least 70 biosimilar development programs currently ongoing, it’s no surprise that there are lots of questions about biosimilars, their efficacy, and safety.

What are biosimilar medications?

Biosimilars are not the same as generic medications. Generics are limited to small-molecule medications made from synthesized chemicals. A generic must be chemically identical to its branded counterpart with the same active ingredient(s). Biosimilars are made of larger molecules derived from living cells, making them difficult to duplicate and manufacture.  As such, a biosimilar product may be approved by the FDA if data demonstrate the product (1) is “highly similar” to the innovator product, in spite of minor differences in clinically-inactive ingredients; and (2) has no clinically meaningful differences from the innovator product in safety, purity, or potency.

How do we know biosimilars are safe and effective?

The FDA approval process for biosimilars is governed by the Public Health Service Act. The process involves comparison of the innovator product with the proposed biosimilars using data derived from analytical studies demonstrating high similarity of the therapeutic proteins. Structural analyses, functional assays, and animal and clinical studies are all conducted and reviewed prior to approval of a biosimilar.

How do biosimilars affect health care costs?

Economically speaking, biosimilars increase competition among manufacturers, reduce prices, and improve patient access to these products. Cost savings of up to 40% are projected from the use of biosimilars instead of the innovator product. Larger discounts are expected as more competitors enter the market. The FDA has made it clear they hope biosimilars will play a role in controlling health care costs. In fact, an abbreviated pathway for FDA approval of biosimilar products has been established by the Biologics Price Competition and Innovation Act of 2009 (BPCI Act). Through the BPCI Act, the FDA seeks to allow the use of established knowledge of a drug, thereby avoiding unnecessary duplication of effort for clinical research, saving time and resources.
Biosimilars are here to stay. Be on the lookout for advances in biosimilar products in the coming years, especially in the fields of oncology, nephrology, and rheumatology.

Update Your Info Online with Provider DataPoint

CMS now requires us to contact our network providers on a regular basis to confirm that our directory information is up to date. We kindly request that you provide us with thirty (30) days advance notice of any changes to your provider/practice information whenever possible. Also, watch for reminders in future editions of The Point to notify us of any changes to your provider/practice information.

Provider DataPoint is our web-based provider data management tool that helps us maintain accurate provider directories and perform timely and efficient claim processing. Using this tool is an easy way to keep all your practice/provider information up to date and accurate.

PLEASE NOTE: We no longer accept updates, changes, and credentialing applications via email or fax. Please also note that radiologists, anesthesiologists, and midlevel providers (NP, PA) who do not practice as PCPs do not require credentialing.

Please use Provider DataPoint to:

• Change your practice information, including name, phone/fax, address, billing information, NPI, etc.
• Add or delete a location to your already-contracted practice/group
• Change provider information, including name, specialty, panel status, add a language, etc.
• Add a provider who requires credentialing to your practice
• Terminate a provider from your practice/group
• Check the status of a previously submitted data change request
• Sign up for Electronic Funds Transfer

To access Provider DataPoint, visit our provider information updates page.

If you have any questions, please see the instructions on our website or speak to a Provider Representative at 1-888-732-7364.

Just for Kids

To assure our youngest health plan members receive quality care, Martin’s Point measures:

• Well-Child Visits in the First 15 Months of Life (W15): A count of the number of well-child visits that occur on or before the child turns 15 months of age.
• Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34): Children from 3 through 6 years of age have one or more well-child visit(s) during the past year. 
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Children from 3 through 17 years of age have an outpatient visit in the past year and the following are assessed.
  • BMI—Documentation of a height, weight, and distinct BMI percentile (BMI ranges and thresholds are not acceptable)
  • Nutrition—Documentation of nutrition being addressed (e.g., discussion of behaviors, referrals for nutrition education, providing educational materials, anticipatory guidance, or counseling for weight or obesity)
  • Physical Activity—Documentation of physical activity being addressed (e.g., discussion of behaviors, referrals for physical activity, providing educational materials, anticipatory guidance, or counseling for weight or obesity)
• Adolescent Well-Care Visits (AWC): Adolescents from 12 through 21 years of age have at least one comprehensive well-care visit during the past year. 

Your Patients Can Join a Local 5-STAR Medicare Advantage Plan Today

Did you know that Martin’s Point Generations Advantage is northern New England’s only 5-STAR Medicare Advantage Plan, and one of only 14 5-STAR plans in the country?  The 5-STAR designation is CMS’ highest rating for quality and service and allows for year-round enrollment (not just during Medicare’s Annual Enrollment Period). That means your patients can join a 5-STAR Generations Advantage plan now.  Medicare Advantage may be a wise choice for many of your patients who are currently enrolled in traditional Medicare. If your patients are interested in joining Generations Advantage, they may contact us at 1-800-603-0652 (TTY:711)