CommercialMedicare AdvantageMedicaidDecember 1, 2024

December 2024 Provider Newsletter

Featured Articles

AdministrativeMedicaidNovember 15, 2024

Targeted rate increase: update

Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality


Administrative

AdministrativeCommercialDecember 1, 2024

Appropriate 911/emergency care procedures

AdministrativeCommercialDecember 1, 2024

Coordination of care

AdministrativeCommercialDecember 1, 2024

Reminder: Direct HMO is coming January 2025

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

AdministrativeCommercialDecember 1, 2024

Case Management program

AdministrativeMedicaidNovember 13, 2024

Updated provider manual now available

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

AdministrativeMedicare AdvantageNovember 15, 2024

California 2025 Medicare Advantage plan changes

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Behavioral Health

Behavioral HealthCommercialDecember 1, 2024

Do you offer telehealth services? Let us know!

Behavioral HealthCommercialDecember 1, 2024

CAA: Maintain your online provider directory information

Behavioral HealthCommercialDecember 1, 2024

BlueCard Program useful tips

Behavioral HealthCommercialDecember 1, 2024

Find answers to BlueCard questions

Behavioral HealthCommercialMedicare AdvantageDecember 1, 2024

Comprehensive, holistic care for obstructive sleep apnea

Education & Training

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

Policy Updates

Policy UpdatesCommercialNovember 6, 2024

Cost transparency

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Policy UpdatesMedicaidOctober 29, 2024

Clinical Criteria updates

Effective January 30, 2025

Policy UpdatesMedicaidNovember 6, 2024

Clinical Criteria updates

Effective February 9, 2025

Prior AuthorizationMedicaidNovember 5, 2024

Prior authorization requirement changes

Effective March 1, 2025

Products & Programs

Federal Employee Program (FEP)CommercialDecember 1, 2024

FEP excited to join PSHB program in 2025

PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

PharmacyCommercialDecember 1, 2024

Pharmacy information available online

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