CommercialMedicare AdvantageMedicaidJuly 1, 2024

July 2024 Provider Newsletter

Featured Articles

Administrative

AdministrativeMedicaidJuly 1, 2024

Anatomical modifiers

AdministrativeCommercialJune 21, 2024

Timely receipt of other carrier EOB or rejection helps avoid timely filing denials

AdministrativeMedicaidJune 14, 2024

Skilled Nursing Facility Workforce and Quality Incentive Program

AdministrativeCommercialMedicare AdvantageMedicaidJune 11, 2024

Phoenix Sepsis Criteria for coding and billing pediatric sepsis

AdministrativeCommercialJuly 1, 2024

CAA: Maintain your online provider directory information

Education & Training

Education & TrainingCommercialJune 13, 2024

Faster notification of EDI corrected claims errors

Education & TrainingCommercialMedicare AdvantageMedicaidJuly 1, 2024

July is Disability Awareness Month

Education & TrainingCommercialMarch 12, 2024

Important reminder: The correct original claim number must be included if submitting a corrected claim

Policy Updates

Policy UpdatesMedicaidJune 20, 2024

Facility emergency department leveling reviews for providers under investigation

Policy UpdatesMedicare AdvantageJune 4, 2024

Clinical Criteria updates

Effective July 6, 2024

Policy UpdatesMedicaidMay 29, 2024

Clinical Criteria updates

Effective August 27, 2024

Policy UpdatesMedicare AdvantageJune 3, 2024

Clinical Criteria updates — November 2023

Policy UpdatesMedicaidMay 30, 2024

Carelon Medical Benefits Management, Inc. updates

Medical Policy & Clinical GuidelinesMedicare AdvantageJune 21, 2024

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

Medical Policy & Clinical GuidelinesMedicaidMay 29, 2024

MCG Care Guidelines 28th edition

Medical Policy & Clinical GuidelinesMedicare AdvantageMay 30, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2024

Prior AuthorizationMedicaidJune 20, 2024

Prior authorization requirement changes effective October 1, 2024

Codes L7510 and L7520

Prior AuthorizationMedicaidJune 17, 2024

Prior authorization requirement changes effective October 1, 2024

Code C9790

Prior AuthorizationMedicaidJune 11, 2024

Prior authorization requirement changes

Effective October 1, 2024
Codes 81173, 81247, 81249, 81307, 81336, 81403, 81405, and 81440

Products & Programs

PharmacyMedicare AdvantageJune 20, 2024

Anthem expands specialty pharmacy precertification list

Quality Management

Quality ManagementMedicare AdvantageJuly 1, 2024

Understanding your role in the Health Outcomes Survey

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