CommercialMedicare AdvantageMedicaidDecember 1, 2023

December 2023 Provider Newsletter

Featured Articles

Products & ProgramsCommercialDecember 1, 2023

Benefit enhancements for CalPERS PPO members

AdministrativeMedicaidNovember 20, 2023

Access to new and improved services

AdministrativeMedicaidDecember 1, 2023

Reminder: Balance billing prohibited

Education & TrainingMedicare AdvantageDecember 1, 2023

Model of care training reminder


Administrative

AdministrativeCommercialDecember 1, 2023

New vendor administering behavioral health access survey

AdministrativeCommercialDecember 1, 2023

Outpatient system updates for 2024

AdministrativeCommercialDecember 1, 2023

Professional system updates for 2024

AdministrativeCommercialMedicare AdvantageMedicaidDecember 1, 2023

New requirements for credentialing and recredentialing

AdministrativeCommercialDecember 1, 2023

Case Management Program

AdministrativeCommercialDecember 1, 2023

Coordination of care

AdministrativeCommercialDecember 1, 2023

CAA: Review your online provider directory information

AdministrativeCommercialDecember 1, 2023

An overview of our medical necessity review process

AdministrativeMedicare AdvantageDecember 1, 2023

2024 Medicare Advantage service area and benefit updates

AdministrativeCommercialDecember 1, 2023

Clinical practice and preventive health guidelines

AdministrativeCommercialDecember 1, 2023

Members’ Rights and Responsibilities

Digital SolutionsCommercialDecember 1, 2023

Clinical Documentation Lookup Tool

Digital SolutionsMedicaidDecember 1, 2023

Filing digital claims disputes: Transparent and trackable

Behavioral Health

Behavioral HealthCommercialDecember 1, 2023

Find answers to BlueCard questions

Behavioral HealthCommercialDecember 1, 2023

BlueCard Program quick tips

Behavioral HealthCommercialDecember 1, 2023

Practice status: open or closed

Behavioral HealthCommercialDecember 1, 2023

Does your practice offer telehealth services? Let us know!

Behavioral HealthCommercialDecember 1, 2023

Timely Access Regulations and Language Assistance Program

Education & Training

Education & TrainingMedicare AdvantageNovember 28, 2023

2024 Medicare Advantage California EAE DSNP Changes

Education & TrainingMedicaidNovember 13, 2023

Population Needs Assessment Provider Bulletin

Policy Updates

Medical Policy & Clinical GuidelinesMedicaidNovember 21, 2023

Medical Policies and Clinical Utilization Management Guidelines update for May 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 21, 2023

Medical Policies and Clinical Utilization Management Guidelines update for May 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 1, 2023

Glucagon-Like Peptide-1 prior authorization changes

Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 17, 2023

Transition to Carelon Medical Benefits Management, Inc. Genetic Testing Guidelines

Medical Policy & Clinical GuidelinesMedicaidNovember 7, 2023

Carelon Medical Benefits Management, Inc. updates

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 


Codes 0738T and 0739T

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes Q4272 - Q4284

Prior AuthorizationMedicare AdvantageNovember 8, 2023

Prior authorization requirement changes effective May 1, 2024 

Code E0761

Prior AuthorizationMedicare AdvantageOctober 31, 2023

Prior authorization requirement changes effective March 1, 2024 

Codes 33275 and 33274

Products & Programs

Federal Employee Program (FEP)CommercialDecember 1, 2023

Federal Employee Program updates member ID cards

Federal Employee Program (FEP)CommercialDecember 1, 2023

2024 Federal Employee Program benefit information available online

PharmacyCommercialMay 31, 2023

Pharmacy information available on our provider website

PharmacyMedicare AdvantageOctober 26, 2023

Notification of specialty pharmacy medical step therapy updates

Quality Management

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 10, 2023

HEDIS 2023 Electronic Clinical Data Systems (ECDS)

CABC-CDCRCM-045262-23

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).