CommercialMedicare AdvantageAugust 1, 2024

August 2024 Provider Newsletter

Administrative

AdministrativeMedicare AdvantageAugust 1, 2024

ICD-10-CM Excludes1 notes

AdministrativeCommercialAugust 1, 2024

Incidental services — facility editing update

AdministrativeCommercialAugust 1, 2024

Device-dependent procedures — facility editing update

Digital SolutionsCommercialJuly 24, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsMedicare AdvantageJuly 16, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & Training

Education & TrainingCommercialMedicare AdvantageAugust 1, 2024

Coming soon: Provider e-Learning Resource Center for Payment Integrity

Education & TrainingCommercialMedicare AdvantageAugust 1, 2024

August is National Breastfeeding Month

Policy Updates

Policy UpdatesMedicare AdvantageJuly 10, 2024

Clinical Criteria updates

Effective August 12, 2024

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

Material adverse change

Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 11, 2024

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

Effective for dates of service on and after November 17, 2024

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

MCG Care Guidelines 28th edition

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Reimbursement PoliciesCommercialAugust 1, 2024

Reimbursement policy update: Modifiers 26 and TC — Professional

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Bundled Services and Supplies — Facility update

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

New reimbursement policy: Intraoperative Neuromonitoring — Professional

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Professional Anesthesia Service

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Incident to Services — Professional

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Outpatient Facility Revenue Code Billing Requirements — Facility

Products & Programs

PharmacyCommercialAugust 1, 2024

Material adverse change

Specialty pharmacy updates — August 2024

PharmacyCommercialAugust 1, 2024

Material adverse change

Correction: Prior authorization updates for specialty pharmacy

COBCBS-CRCM-063083-24