Get the latest on CAHPS, SNP training, and quality measure updates.
PROVIDER MARCH NEWS
New 2025 tools and resources to support your practice
The Devoted Health Provider Portal helps you treat and manage patient care with real-time reporting and easy-to-use tools. Access the Provider Portal today to:
✓ Submit prior authorizations ✓ Verify prior authorization requirements by CPT code ✓ Dispute claims with just a few clicks ✓ View Stars reporting to track performance ✓ Submit supplemental data to close care gaps
You can access the Devoted Provider Portal through Availity Essentials. Learn more about our tools and resources on our Platforms & tools page.
NEW Provider Portal medical record submission tool available
We’ve made submitting medical records for audit requests easier than ever! Our new feature lets you upload documents directly through the Devoted Provider Portal.
To get started, log in to Availity, navigate to Devoted Health’s payer space, from the Devoted Provider portal, select “Claims Requiring Documentation.” There, you can quickly attach medical records for adjudications being audited by Devoted that require documentation. For audits conducted by vendors on behalf of Devoted, the portal has instructions for where to submit these records. Contact our Provider Services team with any questions.
Stars measures for 2025: here’s what’s changing
Participate in HEDIS MRR chart requests
The HEDIS medical record review (MRR) season for measurement year 2024 is underway through the end of April. You may hear from our partners at Datavant (formerly CIOX). We’ve continued to partner with Datavant for medical record retrieval to make the process easier, especially if you’re already familiar with them through other plans. Our goal is to minimize any burden on your team. We appreciate any medical documentation you provided last year to help close gaps for Star Rating measures.
Changes and updates for Stars MY2025
CMS has made some changes to the Stars measures for MY2025. There are 3 new measures being added to all contracts:
MEASURE
GOAL AND ADDITIONAL RESOURCES
Care of Older Adults — Functional Status Assessment (SNP only) (1x-C)
Assess SNP members' current functional status and ability to complete routine daily tasks.
Concurrent Use of Opioids and Benzodiazepines (1x-D)
Low percentage of members ≥ 18 years of age with concurrent use of prescription opioids and benzodiazepines. A lower rate indicates a better performance.
CMS has retired or temporarily removed the following measures:
Care of Older Adults: Pain Assessment (retired) SNP Only
Medication Reconciliation Post-Discharge (retired as standalone measure, still 0.25 weight in the TRC Aggregate)
Listed below are the some of the measure specific changes made MY2025 by CMS:
Colorectal Cancer Screening (COL-E): age range for MY25 changed to 45–75 years old.
Statin Therapy in Persons with Cardiovascular Disease (SPC): added a required exclusion for muscular reactions to statins (can be made a lifetime exclusion).
Our2025 HEDIS Guide is updated with these changes and available to view.
Important CAHPS update
The CAHPS (Medicare Experience Survey) season is underway through the end of May! Selected members will receive the survey through email, mail, or phone with strong encouragement to participate.
We appreciate everything you do to support CAHPS performance throughout the year. Here’s how you can help:
Review Q1 CAHPS provider scorecards
Identify which CAHPS measures need the most focus.
Share any patient engagement or experience strategies you have underway.
Call members on your Q1 CAHPS panel lists
These lists highlight high-risk patients facing challenges with access and care coordination.
Please call these members to schedule PCP visits and return the annotated lists to your network manager. This helps us update and enhance our data continuously.
What we’re doing at Devoted
We’ve launched a mail and email campaign to build survey awareness, ensuring members know how and when they might receive it. These materials cover key topics addressed in the survey. We’ve also increased our Service Recovery program by 5x, proactively reaching out to high-risk members to offer white-glove service support.
Review payment policy updates
NEW Home Health Services Billing:Outlines the coverage criteria and billing requirements for home health services.
NEW Telehealth Services: Establishes the framework for reimbursement of telehealth services, including telephone services, virtual check-ins, and e-visits.
SNP MOC training reminder
The Centers for Medicare & Medicaid Services (CMS) requires all contracted providers who serve our SNP members to complete the Model of Care training every year. Please take a moment to review our 2025 Model of Care and ensure that all providers responsible for caring for SNP members complete the training.
Have questions about our SNP plans? Check out our FAQ Flyer.
Risk adjustment best practices: mental health disorders
About 1 in 4 Medicare beneficiaries live with mental illness, but only 40–50% of them receive treatment. Among Medicare Advantage members, the prevalence is around 28%.
With many psychiatrists opting out of Medicare, primary care physicians play a crucial role in assessing and managing these conditions.
Major depression is often underdiagnosed and undertreated. Among beneficiaries 65 and older diagnosed with depression, about 16% did not have a medication prescribed, and 18% reported not seeing a doctor.
