California
Provider Communications

Policy Update Modifiers 25 and 57

Keep up with Medi-Cal news - March 2023

• Clinical Criteria updates
• Prior authorization updates for medications billed under the medical benefit (Carvykti)
• Prior authorization updates for medications billed under the medical benefit (Aduhelm)

No cost, unlimited LiveHealth Online medical and psychology visits during the California State of Emergency

Keep up with Medi-Cal news - February 2023

• Prior authorization updates for medications billed under the medical benefit (Enjaymo, Kimmtrak, Tezspire, Voxzogo)
• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization updates for medications billed under the medical benefit (Pluvicto, Opdualag, Alymsys, Yusimry)
• Introducing the Provider Learning Hub

Monkeypox and smallpox vaccines: Product code on claims

Engagement with your patient counts

Keep up with Medi-Cal news - January 2023

• Population Needs Assessment report
• Remind your patients to update their Medi-Cal Managed Care information

Update to the Pregnancy Notification Form

New Digital Provider Enrollment tool added to Availity

Keep up with Medi-Cal news - December 2022

• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization updates for medications billed under the medical benefit (Releuko, Vabysmo)

Important information about utilization management

Alcohol use disorders often coexist with psychiatric disorders

Keep up with Medi-Cal news - November 2022

• Prior authorization requirement changes effective November 1, 2022
• Diabetes Prevention Program
• Medical drug benefit Clinical Criteria updates
• No Wrong Door policy

Members’ Rights and Responsibilities section

Reimbursement Policy RETRACTION: Sexually transmitted infections testing – professional

Monkeypox resources and recommendations for our care providers

New specialty pharmacy medical step therapy requirements

Keep up with Medi-Cal news – October 2022

• Prior authorization updates for medications billed under the medical benefit for Tivdak, Saphnelo, Ryplazim

Alcohol use disorders linked to chronic diseases

Reimbursement policy update – Modifiers 25 and 57: Evaluation and Management with Global Procedures

Complex Case Management program

Enhancing claims attachment processes through digital applications

Prior authorization updates for medications billed under the medical benefit

New specialty pharmacy medical step therapy requirements

Keep up with Medi-Cal news – September 2022

• Clinical criteria update

• Access to care standards

HEDIS 2022: Summary of changes from NCQA

Chlamydia screening

Using SBIRT to address opioid and substance use disorders

Updated quality performance requirements

The cost of alcohol use disorder

Prior authorization requirement changes updated effective date November 1, 2022

Prior authorization requirement changes effective August 1, 2022

MCG care guidelines 26th edition

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medi-Cal news – July 2022

• What is an e-Consult?
• Prior authorization updates for medications billed under the medical benefit

Medical drug benefit Clinical Criteria updates

Network adequacy – subcontractor expectations

Keep up with Medi-Cal news – June 2022

• Prior authorization updates for medications billed under the medical benefit
• Provider notification process
• Provider coding education: Webinars and on-demand trainings are now available!

Expedited grievances

Screening for alcohol use disorder in high-prevalence demographics

Keep up with Medi-Cal news – May 2022

• Prior authorization requirement change for HCPCS code K1022
• Provider notification process
• New specialty pharmacy medical step therapy requirements

The Anthem, Inc. name is changing

Reimbursement policy update: Inpatient Readmissions

Disease management/population health program

FDA warns about dental problems with buprenorphine medicines

Clinical criteria updates

Postpartum coverage expansion

Keep up with Medi-Cal news – April 2022

• Prior authorization required for specialty pharmacy drugs
• New specialty pharmacy medical step therapy requirements
• Medical drug benefit Clinical Criteria updates
• Medical Policies and Clinical Utilization Management guidelines update
• Quick tips to filing a complete and correct professional claim

It is CAHPs survey time!

Clinical utilization management guidelines update

Urinary tract infection toolkits are on the way

Keep up with Medi-Cal news – March 2022

• Prior authorization requirement changes — 97535 Self-care/home management training

Get faster payments with EFT

Keep up with Medi-Cal news – February 2022

Botox® update for Anthem Blue Cross members

2021 CAHPS Survey results

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Keep up with Medi-Cal news – January 2022

• Pharmacy services to be fee-for-service benefit
• Prior authorization updates for medications billed under the medical benefit

Good news: Non-payment remittance advice enhancements are here

Policy update: Drug screen testing

Policy update: Drug screen testing, effective March 1, 2022

Submitting prior authorizations is getting easier

Keep up with Medi-Cal news – December 2021

• Durable medical equipment prior authorization requirement changes effective February 1, 2021

• Prior authorization requirement changes

• Medical drug benefit Clinical Criteria updates

• Managed care organization pharmacy benefits transitioning to the Medi-Cal Rx program

• Medical Policies and Clinical Utilization Management Guidelines update

Discharges against medical advice

4 things you can do to encourage cancer screenings for your women patients

Electronic data interchange process

Claims editing update for ICD-10-CM Excludes 1 notes

Clinical criteria updates

Unspecified diagnosis reminder

Pharmacy services to be fee-for-service benefit

Diabetes testing and screening HEDIS measures

New policy: Sexually transmitted infections testing, effective January 1, 2022 - professional

Get your payments faster when you sign up for electronic funds transfer

Keep up with Medi-Cal news – October 2021

• 2021 affirmative statement concerning utilization management decisions

• May 2021 Medical Policies and Utilization Management Guidelines update

Keep up with Medi-Cal news - September 2021

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross results in improved care management for patients

Coding spotlight: Mental disorders in childhood

What matters most: Improving the patient experience

Resources to support your diverse patient panel

Infusion step therapy retraction notice

Specialty pharmacy prior authorization retraction notice

February 2021 medical policies and utilization management guidelines update

Prior authorization requirement changes effective September 1, 2021 – UM AROW 1327

Certain specialty medication precertification requests may require additional documentation

Let’s vaccinate

Prior authorization requirement changes effective October 1, 2021 – UM AROW 1837

March 2021 medical drug benefit clinical criteria updates

Provider education program survey: Your voice counts

MCG care guidelines 25th edition

Prior authorization updates for specialty pharmacy

Keeping up with routine vaccination during COVID-19

Aspire Health for members in need of palliative care

Member grievance and appeals process

Complex case management program

Important information about utilization management

Members’ rights and responsibilities statement

Continuing medical education / continuing education unit opportunities

Metabolic monitoring and diabetes screening measures for those on antipsychotics medications

2020 Anthem Blue Cross population needs assessment

Coding spotlight: Tips and best practices for compliance