CommercialMedicare AdvantageMedicaidAugust 1, 2024

August 2024 Provider Newsletter

Featured Articles

Policy UpdatesMedicaidJuly 19, 2024

Access to care standards

Administrative

AdministrativeMedicare AdvantageAugust 1, 2024

ICD-10-CM Excludes1 notes

AdministrativeMedicaidAugust 1, 2024

Mutually exclusive places of service

AdministrativeMedicaidAugust 1, 2024

Review your online provider directory information

Digital SolutionsCommercialJuly 24, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsMedicare AdvantageJuly 16, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Behavioral Health

Behavioral HealthCommercialAugust 1, 2024

Participate in our access to care surveys and use our language assistance program

Behavioral HealthMedicaidAugust 1, 2024

Learn to Live: A Digital Mental Health Benefit for Anthem Blue Cross members!

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaidAugust 1, 2024

Coming soon: Provider e-Learning Resource Center for Payment Integrity

Education & TrainingCommercialMedicare AdvantageMedicaidAugust 1, 2024

August is National Breastfeeding Month

Policy Updates

Policy UpdatesMedicaidJuly 9, 2024

Claims timeliness

Policy UpdatesMedicare AdvantageJuly 10, 2024

Clinical Criteria updates

Effective August 12, 2024

Policy UpdatesMedicaidJune 27, 2024

Carelon Medical Benefits Management, Inc. updates effective October 20, 2024

Policy UpdatesMedicaidJuly 18, 2024

MCG Care Guidelines 27th edition update

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

MCG Care Guidelines 28th edition

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 17, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after April 14, 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 11, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after November 17, 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Prior AuthorizationMedicaidJune 27, 2024

Prior authorization requirement changes

Effective October 1, 2024
Code L5615

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

Reimbursement PoliciesMedicare AdvantageMedicaidAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

PharmacyMedicaidJuly 18, 2024

Prior authorization updates for medications billed under the medical benefit

CABC-CDCRCM-063082-24