Provider Notices

Provider Relief Plan

3/27/2020 3:22:15 PM

Dear Provider Partner:

As we all deal with the spread of coronavirus, collaboration and partnership are more important than ever.   We recognize and appreciate the work you are doing to provide ongoing care for patients, treat individuals who have contracted the virus and prepare for the expected surge. We thank you for your dedication and service.

We also know that many of you are facing financial, staffing and bandwidth challenges.  To help provide some relief, we are immediately suspending the following processes and requirements until June 30th:

  • Prior authorization of medical care and procedures (except prior authorization of drugs)

  • Medical concurrent review (but we will continue to support providers and members in transitions of care)

  • Referral Authorizations

  • Re-Credentialing

  • Credentialing delegation audits

  • Provider access surveys

  • Most required provider reporting

  • Most medical record requests

We will also extend existing prior authorizations until the end of September.

In addition, we will pay out 70% of our best estimate of withhold returns and incentive payments for our various 2019 risk agreements.  We will be processing these payments in the next two weeks. We will complete final reconciliations on those programs as scheduled later this summer.

Additional information will be forthcoming on the specifics of some of these actions.  We have created an FAQ to answer some of the common questions we have received. The Emergency Temporary credentialing application is NOT relevant to providers and or groups that do NOT have an active contract in place.  Please contact our teams if you have any questions.

Finally, you should know that essentially all members of our team are now working remotely, that the transition has gone well and that we remain fully functional.  Our leadership team has a daily call to monitor the situation and make adjustments as necessary.  To that end, we will re-evaluate the June 30th end date as we move through the coming months.

Thank you and take care of yourselves.


Kenneth P. Provencher

President and CEO