Bone Densitometry – Effective January 3, 2011

Dear Participating Provider:

     Gateway Health Plan® (Gateway) is pleased to announce that effective January 1, 2011 prior-authorization requirements for Bone Densitometry procedures have been lifted. Medical necessity review through National Imaging Associates, Inc.(NIA) will no longer be required for your Gateway Medicaid or Medicare Assured® HMO SNP patients. Simply write a script and send your patient to a Gateway participating provider for the outpatient diagnostic test!

      Gateway has plans in place to notify our female members age 65 and older of this change and remind them of the importance of having a screening test. Members will be encouraged to contact their physician to obtain a script for the BMD screening. In addition to writing a script for your female members age 65 and older Gateway encourages physicians to consider the medical appropriateness of a BMD screening and/or drug to treat or prevent osteoporosis for your female Medicare Assured® members over the age of 67 who suffered a fracture.

    Finally, if you are treating a Gateway member and you are not the member’s Primary Care Physician (PCP) please be sure to send consultation reports and test results back to the PCP listed on the member’s Gateway ID card to help ensure the patient’s care is safe, proper, and unduplicated. Addresses are located in the Provider Directory on Gateway’s website, www.GatewayHealthPlan.com, (Provider Look-up and plan). Failure to share information about the care of a patient can result in suboptimal outcomes, increased costs, and medical errors.

    This change is in keeping with our commitment to lessen the administrative burden for our provider network and promote continuous quality improvement and member access. If you have any questions regarding this policy change please contact your Provider Relations Representative or the Provider Services Department at 1-800-392-1145 for Medicaid or for Medicare Assured® inquiries call 1-800-685-5205.
 
Sincerely,

 Provider Relations Department Gateway Health Plan®