Explore plan changes and tools to support your practice.
PROVIDER DECEMBER NEWS
Devoted Health named top 2025
Medicare Advantage company
We're proud to be recognized by U.S. News & World Report as one of the “Best Insurance Companies for Medicare Advantage in 2025.” Devoted Health was one of just four companies to earn “Best Overall” recognition and "Best Medicare Advantage provider for Screening & Prevention and Care Continuity." Learn more about our continuing success.
Devoted continues to receive high marks for clinical and service quality performance, with 88% of rated-plan members enrolled in 4-Star or higher plans.* Our 2025 weighted average of 4.3 Stars surpasses the national average of 3.9, all during market expansion and a year in which CMS raised its standards for high performance. Read more about our Star Ratings
Get ready for the new plan year
Review our 2025 coverage updates that could impact medications that your patients take
Access our website for a full list of plan and coverage information
PrEP for HIV national coverage determination
Beginning September 30, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) that transitions coverage for Pre-exposure Prophylaxis (PrEP) and other related services to prevent HIV from Medicare Part D to Medicare Part B. Under Part B, beneficiaries will have no cost-sharing obligations (i.e., deductibles or copays). For more information, pharmacies should visit the CMS Fact Sheet.
Oral phosphate binders
Starting January 1, 2025, members will receive this medication at their dialysis center as part of the ESRD bundled payment system under Part B, instead of the pharmacy.
Verify your patient's benefit coverage
You can check member eligibility, submit referrals and prior authorizations, plus check on claims through our Provider Portal. How to access our Provider Portal
2025 Inflation Reduction Act changes
Providers should be aware of these IRA changes going into effect for 2025 to better assist patients in managing their medication costs and adherence.
The most a member will have to pay out of pocket in 2025 for Part D drugs in a year is $2,000
Elimination of the donut hole (coverage gap phase)
Members will still get $35 insulin copays per 30 days supply and $0 cost share in the catastrophic phase
Introduction of the M3P (MPPP/Medicare Prescription Payment Plan) program: M3P helps Medicare members afford their prescriptions by spreading the costs over monthly invoices instead of paying the full amount to their pharmacy
Inpatient Readmission: Revision of existing policy with an updated exclusions list and expanded readmission types
C-SNP verification form
We need your help to confirm a new C-SNP member’s chronic condition if asked. In 2025, a provider verification will be required once Devoted receives a signed verification form from a member’s current provider (PCP or specialist). This form must be submitted within the first 60 days of enrollment to prevent a member from losing their Devoted Health plan and benefits. We'll send you a copy of the member’s verification form that you can complete and fax to 1-877-264-3859.
Closing Stars gaps and a new HEDIS MRR season ahead
As we close out the year, be sure to review open care gaps in the Stars Actionable Gap Report and submit any outstanding data to our Stars team through the Provider Portal. If you have gaps that require a visit, please be sure to schedule one before the end of the year. Our deadline for data submission is February 28, 2025. You can submit supporting documentation to close gaps by uploading to the Provider Portal, uploading to a SFTP, sending a fax to 877-420-4662, or emailing stars@devoted.com.
HEDIS Medical Record Review (MRR) begins in February 2025
You may hear from Datavant (formerly CIOX) to make this process as easy as possible. During MRR, 411 members are selected for each hybrid measure in each contract, which determines our final rates.
Tips and documentation reminders
Drug therapy for osteoporosis in women
Here are some tips for managing bone health in your patients:
Follow up after their fracture to complete a bone mineral density test or start drug treatment within 6 months.
Medication options:
For mild to moderate osteoporosis, consider a Alendronate weekly tablet or Ibandronate monthly tablet
For Severe osteoporosis, consider a Teriparatide injection620mcg/2.48ml (comparable to Forteo)
Patient risk scores reset each year on January 1. Revalidating all active and chronic conditions ensures that a patient’s true disease burden is reported. Be sure that your documentation is supported by including a status and plan for each condition.
This quick guide can help you submit 13 or more diagnosis codes using CPT 99499 on additional claims
Check out Devoted’s resources tab in Availity for multiple coding tip sheets
Review the Provider Portal:it's updated daily, making it a great resource for PCP visit reporting, accessing printable Clinical Gap Forms with disease and Stars gaps
If you are interested in clinical documentation feedback or have any questions, email RAF@devoted.com
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