Skip to main content

SCOPE | Provider Update

May 2024

Clinical Matters

Type 2 diabetes treatment with Metformin 500mg ER tablets

Benefits of extended-release vs. immediate-release tablets for your patients.

Metformin is a cornerstone of therapy for type 2 diabetes, and stands out for its efficacy, safety profile, and cost-effectiveness. However, the choice between immediate-release (IR) and extended-release (ER) formulations of Metformin can significantly impact treatment adherence, tolerability, and ultimately patient well-being. 

Prescribing Metformin ER should be favored over IR formulations for patients with type 2 diabetes for the following reasons:

  • Improved tolerability as GI side effects are reduced by up to 50% when a patient switches from IR to ER tablets
  • Increased medication adherence given the decreased adverse drug reactions
  • No increase in cost for patients – both the IR and ER tablets have the same cost-share per our formulary coverage
  • No supply chain issues, unlike some of the newer brand name medication options.

Metformin ER is a safe and effective therapeutic option to achieve glycemic goals in patients with T2DM without established ASCVD. Metformin can lower A1c by 1-1.5% and has a minimal risk for hypoglycemia. Additionally, metformin is weight neutral.

What should I tell my patient about the ER formula?

Metformin poses minimal risk of low blood sugar, is affordable, doesn’t cause weight gain, and there are currently no issues with its availability at the pharmacy. Metformin ER should be taken with food and swallowed whole. This dose will be slowly increased to reduce GI side effects.

Does prescribing the 500 mg ER formula cost more?

No. Both the IR and ER formulations are Tier 1 generic drugs. And when prescriptions are written for 90- or 100-day supplies, patients can save even more and reduce trips to the pharmacy.

My patient failed Metformin before. Should I attempt a retrial?

When the patient’s glomerular filtration rate (GFR) is above 45, we recommend a retrial – especially if the patient was previously on the immediate-release formulation or initiated at too high a dosage.

In summary, always opt for the extended-release formula when prescribing Metformin for the management of type 2 diabetes. Remember to go low and slow; Titrate by 500 mg every 7 days over several weeks based on kidney function and tolerability, aiming for a daily maximum of 2,000 mg.

Together, we can help patients achieve better glycemic control.

Keys to help patients improve asthma management

Asthma is a chronic lung disease that requires complex medical management.

According to the Centers for Disease Control and Prevention (CDC), 8.7% of U.S. adults have asthma, and 6.2% of children younger than 18 years have asthma. 

Adults ages 18-55 years had the highest lifetime prevalence rates compared to other age groups at 14.7 percent in 2018.

Females (14.1%) were about 10 percent more likely than males (11.8%) to ever have been diagnosed with asthma in 2018.

Blacks are generally more likely than other races and ethnicities to be diagnosed with asthma over their lifetime.

Addressing Asthma symptom management, avoidance of triggers and utilizing asthma action plans are the key ways in which asthma can be controlled. Some key interventions may include:

  • Following evidenced based guidelines for asthma care.
  • Prescribe Controller (maintenance) medicine, as indicated.
  • Prescribe Rescue inhaler, as indicated.
  • Educate patients regarding proper inhaler technique.
  • Educate about avoiding asthma triggers.
  • Utilize Asthma action plans with patients.

For more information and resources, please visit: Learn How To Control Asthma | CDC

NYSDOH requires hepatitis C screening as of May 3, 2024

Requirement aligns with CDC recommendation to screen all adults aged 18 and older.

The Centers for Disease Control and Prevention (CDC) recommends that primary care providers screen all patients 18 years and older at least once in their lifetime for hepatitis C, a liver infection caused by the hepatitis C virus (HCV).

Routine periodic testing is also recommended for people with ongoing risk factors.  Chronic HCV infection does not cause symptoms in most people but can lead to cirrhosis and liver cancer. 

Without treatment, HCV infection can lead to severe liver disease, liver cancer, and even death. Hepatitis C can be cured; testing is the first step.

Why should all adult patients be tested?

  • New cases of hepatitis C are on the rise, particularly among reproductive age adults. Rates of new HCV infections increased by more than 60% from 2015 to 2019. And in 2019, more than 63% of HCV infections occurred among adults 20-39 years of age.
  • Your patients aren’t aware of their risk. Almost half of people with hepatitis C are unaware of their infection. Testing is the first step to accessing curative treatment. Without treatment, approximately 15-20% of adults with chronic HCV infection will develop progressive liver fibrosis and cirrhosis.
  • Hepatitis C can be cured. Over 90 percent of people infected with HCV can be cured with 8-12 weeks of oral therapy. Treatment of hepatitis C is associated with reductions in mortality among persons with chronic hepatitis C

New York State implements Hepatitis C screening requirement effective May 3, 2024

Beginning May 3, 2024, New York State will require that all persons 18 years of age and older and persons under the age of 18 with a risk, be offered a screening test for hepatitis C. These new requirements align New York State with the current Centers for Disease Control and Prevention HCV screening recommendations.

Nationally, new cases of hepatitis C are on the rise, particularly among adults of reproductive age. The number of new hepatitis C infections has doubled since 2014.

Download and read the letter from the New York State Department of Health about this new requirement; the letter includes helpful links to a number of related resources.

For additional information and resources, please visit: Hepatitis C resources for health care providers | CDC

Office Matters

Family Choice plan enhances quality of care and life for residents of nursing homes and assisted living facilities

Independent Health's Medicare Family Choice HMO I-SNP plan provides extra support to individuals in assisted living facilities.

If you have patients who reside in a nursing home or assisted living/adult care facility, Independent Health’s Medicare Family Choice® HMO I-SNP plan* may be able to provide them with an extra level of support to meet their special needs while working closely with you to improve their health outcomes and quality of care.

How the plan works

Upon enrollment, each Family Choice member is assigned an Interdisciplinary Care Team consisting of the member’s Primary Care Provider (PCP), a Family Choice Nurse Practitioner (NP) or Physician Assistant (PA), and a Family Choice Social Worker/Care Manager. The specially-trained NP or PA is on call 24 hours a day, seven days a week to provide care and support any time it’s needed. Their responsibilities include:

  • Working in collaboration with the member’s PCP and the facility’s staff to identify potential problems before they become serious.
  • Providing as many clinical services as possible in the member’s residence.
  • Minimizing unnecessary and disruptive emergency room visits and hospital stays whenever it’s safe and appropriate.
  • Keeping in close contact with the member’s PCP and family, updating them about the member’s condition and making sure that they are involved in the care-planning process. 

Other key features of Family Choice 

  • Low or no out-of-pocket costs
  • Year-round enrollment open to all eligible Medicare beneficiaries
  • Monthly on-site medical assessments and visits
  • Individualized care plan that addresses the member’s needs and health care preferences  
  • Single point of contact nurse or coordinator for benefit authorizations and care transitions
  • Transportation to and from off-site doctor appointments

Impressive survey results

Over the years, the Family Choice plan has consistently received high satisfaction marks from families and caregivers. A recent survey** of people whose loved ones are enrolled in the program showed:

  • 99% would recommend Family Choice to others.
  • 98% feel their NP or PA provides their loved ones with the quality of care they expected them to receive.
  • 97% are satisfied with Family Choice.

To learn more

Nearly 40 facilities nursing homes and assisted living/adult care facilities in Western New York currently participate with the Family Choice plan. For additional information, you and your patients may visit our website.


Independent Health is a Medicare Advantage organization with a Medicare contract offering HMO, HMO-SNP, HMO-POS and PPO plans. Enrollment in Independent Health depends on contract renewal. *This plan is available to all Medicare eligibles that are entitled to Medicare Part A and enrolled in Part B. Members must reside in a participating facility in Western New York. Members must receive all routine care from participating providers. **Survey conducted by Independent Health in July 2023 with 707 families surveyed and 178 families (25%) responding.


Prior authorization for Low-Dose CT no longer required

Prior authorization removed as of June 1; we will follow USPSTF guidelines.

Independent Health will no longer require providers to obtain prior authorization for low-dose CT for lung cancer screening (CPT 71271) as of June 1, 2024.

Independent Health will follow the United States Preventive Task Force Guidelines (USPSTF). The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20-pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

If you have any questions, please contact Independent Health’s Provider Relations department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.

New claims edits for automated editing system effective May 26, 2024

Claims editing process aligns with Medicare local & national coverage determinations.

Independent Health uses claim editing to align claim payment more closely to clinical best practices and industry standard coverage and coding guidelines. For claims processed on or after May 26, 2024, Independent Health will be deploying additional edits to our automated front end editing system.

For details on these new and future edits, please refer to the Coding section of the provider portal; here you will find a detailed spreadsheet that includes the edit criteria, effective date, and applicable lines of business. This chart is updated monthly to include new and updated edits. Please be sure your practice routinely reviews this grid to ensure accurate claim submission for Independent Health.

We believe this process will enable you and your billing staff to more readily understand our payment of claims given the widespread use of these policies, because it will also bring our processes in line with other local health plans.

As a reminder from previous communications, the goals of this claims editing process are to:

  • Increase claim submission accuracy;
  • Bring us to closer adherence to Local and National Coverage Determinations by Medicare;
  • Align more closely with clinical guidelines.  

Independent Health uses the Centers for Medicare and Medicaid Services as a basis for many of these edits, along with specialty society recommendations and clinical best practice guidelines.

Helpful Tips

  • Check the chart regularly to make sure your medical documentation and claim submission align with Independent Health’s requirements. This will help with timely claim processing and payment. 
  • Keep your office staff updated to ensure that you have processes in place to support your decision-making when delivering care to our members.
  • Continue to follow current Independent Health policies, as well as the Notice of Denial of Medical Coverage (NDMC) processes when applicable.
  • Please share this information with all health care providers, office staff and billing staff.


Independent Health engages vendor to enhance credentialing process timeline

New vendor will begin work week of April 29.

Independent Health has contracted with symplrCVO, to help address the credentialing processing in an effort to improve the credentialing timeline.

If symplrCVO needs information during the credentialing process, a representative will contact the individual identified in CAQH as the credentialing contact for the provider.

SymplrCVO will request documents by email and will provide a secure link to the provider’s office upon request if the provider needs to send sensitive or confidential information. 

We will begin working with SymplrCVO the week of April 29.

Upcoming member campaigns to encourage our members to take greater control of their health

Throughout the year, the Health Care Services and Population Health Management Departments deploy various tactics to encourage members to take a more active role in their health.

Beginning in May, Independent Health will conduct the following member engagement/outreach campaigns:

Falls Prevention Campaign

This campaign targets Medicare members who have been identified as having a high likelihood of falls. 

This campaign includes telephone calls to members around falls and ways to prevent falling; it will also include emails to our Medicare population, providing education about fall prevention, and encouraging members to speak to their doctor about ways to prevent falls.

  • Targeted Cohort: Medicare members who have a high likelihood of falling or a history of falls.
  • Launch Date: telephonic outreach will begin in late April.  The email campaign will occur in May through July.


Physical Activity Campaign

This campaign targets Medicare members who have been identified as having low physical activity levels.

This campaign includes telephone calls to members about their physical activity and ways to increase their activity level. It will also include emails to our Medicare population, providing education about benefits of physical activity, encouraging members to speak to their doctor about ways to be more active.

  • Targeted Cohort: Medicare members who have low physical activity levels.
  • Launch Date: telephonic outreach will begin in late April, the email campaign will occur in May through July

Pharmacy Updates

Formulary and Policy Changes

Stay up-to-date on Independent Health's pharmacy policies and formulary updates.

Formulary Deletions
The following documents are available in PDF. Please download them, as they contain important information and updates.

Magellan Rx, administered by Magellan Rx Management, reviews select specialty drug prior authorization requests on Independent Health’s behalf. To view Magellan Rx policies for the drugs that they review, click here.


Independent Health's drug formularies
Access Independent Health's drug formularies here.

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.


In the News

Reddy Bikeshare launches ninth season - IH news, Mar. 29, 2024

The Reddy Team turned on the bikeshare network in late March. It is not only the system’s largest season launch to date, but it is also its first to include Reddy+, the name of the new pedal-assist e-bikes, as well as East Side Forward Pass, a discounted bikeshare pass targeting residents who live on Buffalo’s east side.


Top Takeaways this Month

2024 Fraud, Waste, Abuse and Cultural Competency Awareness attestation now open. Get details on the process here.