February, 2025 Hometown Health Provider Pulse

Important updates and notifications for Hometown Health’s provider partners.

Here’s What’s New at Hometown Health

Milliman Clinical Guidelines

Hometown Health is committed to ensuring you have the tools and resources needed to deliver the highest quality care to your patients. To support you in this mission, we are pleased to announce that Milliman Clinical Guidelines (MCG) are now available on our website for your convenience.

You can access the guidelines at any time by visiting our website at the following link:

Provider Partners | Hometown Health

Through this new resource, you can now view and reference MCG guidelines to assist with patient care and treatment planning. These guidelines provide evidence-based recommendations to support clinical decision-making and help ensure the delivery of consistent, high-quality care.

Important Disclaimer Regarding Medical Necessity

While MCG guidelines are a valuable resource, it is important to note that they are not the only guidelines utilized in making medical necessity determinations. Clinical decisions are based on a comprehensive review of all available information, which may include other evidence-based guidelines, individual patient circumstances, and professional judgment.

We encourage you to explore this new resource and integrate it into your practice as needed. Should you have any questions or require further assistance, please do not hesitate to reach out to our team. We are here to support you and your patients every step of the way.

Thank you for your continued partnership in providing exceptional care.

Behavioral Health Interns – Administrative Guidelines for 2025 Update

When a Behavioral Health Intern becomes fully licensed it is important to inform Hometown Health of the change in licensure! Please email HTHCredentialing@hometownhealth.com for Behavioral Health Intern license updates! Our credentialing team will verify the license and make the necessary updates to our system, including the directory. If you think claims need to be reprocessed because of the new licensure, please complete the Over/Under Large Payment Claim Adjustment Form if an adjustment is needed on 10 or more claims. For fewer than 10 claims, please follow the appeal process as outlined in the Claims Reconsiderations section of our Administrative Guidelines.  You can View the 2025 Hometown Health Administrative Guidelines Here

Please Allow 30 Days Before Calling to Check Claim Status OR use Epic Care Link for Faster Updates

To better serve our members and our providers, we kindly ask you to wait at least 30 days before calling to check the status of a claim. Did you know that 95% of claims are processed and paid within 30 days?

For the fastest and most convenient way to check claim statuses, we encourage you to sign up for Epic CareLink. With Epic CareLink, you can access claim updates online anytime, without the need to call. If you’d like assistance setting up your Epic CareLink account, our representatives would be happy to guide you through the process.

By checking claims online or waiting 30 days before reaching out, you’re helping us reduce phone wait times and improve service for our entire provider and member community. Thank you for your understanding and partnership!

Medication Adherence

One of the most impactful ways you can help a patient is encouraging  medication adherence. Studies consistently show that patients who follow their prescribed medication regimens experience better health outcomes, fewer hospitalizations, and lower overall healthcare costs.

To support your ongoing efforts, we’d like to offer some practical strategies to help your patients stay on track with their medications:

1. Simplify Medication Regimens: Where possible, consider consolidating dosages or exploring combination therapies to reduce complexity for patients.
2. Engage in Open Communication: Discuss potential side effects, cost concerns, and the importance of adherence with your patients. This year, Medicare Part D is different, and we’re hopeful it will help more patients afford their medications.
3. Prescribe 100-Day Supplies with 3 Refills for Chronic Medications: Research shows that adherence improves when providers offer 100-day supplies with 3 refills. If you’re unsure how to provide a 100-day supply, simply add “QS 100-day supply with 3 refills” in your prescription notes, and the pharmacy can calculate the correct amount.
4. Encourage Follow-Up: Regular follow-ups or check-ins can help identify and address any barriers to adherence early on.
5. Utilize the Renown Pharmacies: The Renown Pharmacy team is dedicated to supporting both providers and patients with unique resources to help ensure better medication management Pharmacy | Renown Health.

Your compassionate care and guidance are essential in helping patients overcome barriers like cost, forgetfulness, or misunderstandings about their treatments. By providing a supportive and proactive approach, you can make a real difference in their health and well-being.

Ensuring Accuracy: Hometown Health’s Annual Benefit and Provider Contract Audit

Each year Hometown Health conducts a comprehensive audit of our benefit configuration and provider contract fee schedule setup to ensure claims are processed correctly the first time.

We are proud to share that this year’s 2025 Benefit and Provider Contract Audit results reflect a 99% accuracy rate—a testament to our team’s dedication to precision and continuous improvement. This achievement underscores our commitment to seamless claims processing and strong provider partnerships.

As we move forward, we remain focused on enhancing our systems and processes to uphold this high standard. We deeply appreciate the collaboration of our provider community and look forward to continuing to serve our members—together!

Important Reminders For Provider Partners 

Report Directory Discrepancies

Having accurate information in our online provider directory is essential for members to find and access care quickly. However, issues such as incorrect contact details, outdated provider listings, or missing information can cause delays and confusion.

We ask that you take a moment to review your listing in the Hometown Health Online Provider Directory and report any discrepancies you find. You can do so by clicking the “Report Discrepancy” button or by emailing providerupdates@hometownhealth.com.

Please check the following information:

• Name
• Address
• Phone/Fax Number
• Languages Spoken
• Race & Ethnicity
• Gender
• Hospital Affiliations
• Cultural Training
• Specialties

Additionally, attesting to the accuracy of directory information through our partnership with Quest Analytics will help ensure our directory is accurate!

By reporting discrepancies promptly, you help us ensure that Hometown Health continues to provide reliable resources for our members.

Is Your Photo on our Provider Directory?

Adding your photo to the online directory helps humanize your profile. People are more likely to engage with a person they can visually recognize, which builds trust and credibility. 

Profiles with photos tend to get more attention than those without. A clear and professional image can make you stand out and increase your visibility!

To add your photo to our online directory, visit the Forms and Resources section of our website, and click on ‘Upload Your Photo for our Provider Directory.’

Effective 6/1/2025: Attestation is Required

Starting June 1, 2025, Hometown Health will remove any providers or facilities that have not attested to their information in the last 365 days from our directories. Since January 1, 2022, the No Surprises Act has required providers and facilities to confirm their demographic details every 90 days. To avoid being removed from the directory, please complete your attestation today!

To avoid removal from the directory and make this as easy as possible for you, Hometown Health has partnered with Quest Analytics’ BetterDoctor to collect your quarterly provider data attestations. There are two options to attest:

• Attest via the BetterDoctor portal using the secure access code you receive from Quest Analytics’ BetterDoctor via email, fax, and/or direct mail each quarter. OR
• Attest via roster if your organization includes 20 or more practitioners at multiple service locations. Please send your quarterly roster to rosters@questanalytics.com.

For more information on the attestation process and the No Surprises Act, please visit: PRACTITIONER DATA VERIFICATION

Adding New Providers?  Avoid Delays By Ensuring CAQH Is Up To Date

Credentialing can take time, so it’s important to avoid delays by ensuring the following information is up-to-date in CAQH when requesting to add providers to your TIN:

• Practice State
• Practice locations
• Current licensure
• Re-attested within the last 120 days
• Updated professional liability (malpractice) insurance
• Five-year work history, including current work history and explanations for any gaps longer than six months
• Current hospital affiliations
• All disclosure questions answered, with explanations for any “yes” responses

Please be aware that the credentialing process can take anywhere from 90 to 180 days to complete.

At Hometown Health, the average turnaround time (TAT) for credentialing in 2024 was approximately 44 days. However, it’s important to note that if the above requirements are not met, you may be contacted by andros,* our Credentials Verification Organization, or Hometown Health credentialing specialists to update. To avoid potential holdups, we strongly encourage you to work closely with the Hometown Health credentialing specialists as well as with andros* to ensure all necessary updates are made in CAQH and that all required forms are received status

Provider Dispute Reminder 

If you do not agree with the outcome of the provider reconsideration, you may resubmit another reconsideration with additional supporting documentation for review which must include new and material evidence to support a re-opening of the initial reconsideration. If there is no new material evidence, the reconsideration will be dismissed as a duplicate submission. All claim reconsiderations and disputes must be submitted within 90 days from the date of explanation of payment unless otherwise outlined in the provider agreement.

Reminder of TATs for Prior Authorizations

The standard turnaround time (TAT) for a prior authorization request is 14 days. However, an expedited request may be needed if the standard TAT (14 days) for making a determination could seriously jeopardize the life or health of the patient or the patient’s ability to regain maximum function.

The urgent TAT is 72 hours, with the exceptions of Part B drugs and Biomarker Testing. For Part B drugs and Biomarker Testing, the urgent TAT is 24 hours, while the standard TAT remains 72 hours.

Tips and Tricks for Timely Turn Arounds

EpicCare Link Updates

Additional Topics have been added when Creating a New Message under Customer Service Request.

You can now select from the additional topics:

• Corrected Claim
• Medical Record Request
• Voided Claim Request

Once a topic has been selected, please follow the same steps noted in the New Customer Service Request and complete any required fields.

Please note, Corrected Claim topic should be used when a provider is submitting a correction to a claim on file. This is not considered an appeal.

Claims Reconsideration topic should be used if the provider disagrees with how a claim has processed for denials or payments.

Building Partnerships with Hometown

The Hometown Health Medical Affairs Committee is still looking for new members! The statewide physician committee consists of providers across a variety of specialty types who review physician applicants to the Hometown Health network to determine participation based on the Hometown Health Standards of Participation. For more information or to get involved, please visit: Medical Affairs Committee | Hometown Health