California
Provider Communications

Action required: 2023 Consumer Grievance and Appeals attestation Requirement

Medical Oncology Program ProviderPortal case entry enhancements

Authorizations for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services for consumers with individual, group retiree solutions (GRS), and dual-eligible plans from Medicare Advantage

Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures

Attention lab providers: COVID-19 update regarding reimbursement

Helping to reduce delays when submitting attachments

Confidential communication of medical information

CAA: Maintain your online provider directory information

Survey for all skilled nursing facilities

Submitting prior authorizations is getting easier

Let’s Vaccinate

Pay Doctor Bill (provider payment option) - General FAQ

Pharmacy information available on our provider website

HEDIS 2023 Federal Employee Program medical record request requirements

Ready, set, renew!

Keep up with Medi-Cal news - April 2023

• Clinical Criteria updates
• Important: Continuity of Care updates

E-visits

Keep up with Medicare News - April 2023

• Clinical Criteria Updates
• Anthem Blue Cross expands specialty pharmacy precertification list (Imjudo, Pedmark, Tecvayli, Tzield, Vegzelma)
• Anthem Blue Cross expands specialty pharmacy precertification list (Elahere)
• New specialty pharmacy medical step therapy requirements
• Genetic testing CPT code list update for Carelon Medical Benefits Management (formerly AIM Specialty Health)
• Clinical Criteria updates

March is National Colorectal Cancer Awareness Month

Time to prepare for HEDIS medical record review

Provider directory - annual audit

Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 - Site of care reviews

Advancing Mental Health Equity for Youth & Young Adults

Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews

Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023

Pharmacy information available on our provider website

Change to nonparticipating mental health facility services reimbursement for CalPERS

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)

Annual planned visits

Controlling High Blood Pressure and Submitting Compliant Readings

Western Teamsters Welfare Trust offers Medicare Advantage option

Informational Update Modifier Usage

Shared savings and transition care management after inpatient discharges

Keep up with Medicare News - March 2023

• Carelon Medical Benefits Management, Inc. Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT code list update
• Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines
• Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Clinical Criteria updates
• Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List
• New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)