CommercialMedicare AdvantageFebruary 1, 2024

February 2024 Provider Newsletter

Administrative

AdministrativeCommercialFebruary 1, 2024

CAA: Have you reviewed your online provider directory information lately?

AdministrativeCommercialFebruary 1, 2024

Notice of change to inpatient submission process

Digital SolutionsCommercialFebruary 1, 2024

Update: Training for digital requests for additional information (Digital RFAI)

Digital SolutionsCommercialFebruary 1, 2024

RETRACTED: Beginning in March 2024, you can submit Behavioral Health prior authorizations through the Authorization application on Availity.com

Behavioral Health

Behavioral HealthMedicare AdvantageFebruary 1, 2024

Medicare allowing LMFTs, LPCs, and LACs to enroll

Education & Training

Education & TrainingCommercialMedicare AdvantageNovember 1, 2022

Participating lab referrals help our members most

Policy Updates

Policy UpdatesMedicare AdvantageJanuary 18, 2024

Clinical Criteria updates — September 2023

Policy UpdatesCommercialFebruary 1, 2024

Material adverse change

MCG Care Guidelines 27th edition update

Medical Policy & Clinical GuidelinesCommercialFebruary 1, 2024

Material adverse change

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationCommercialFebruary 1, 2024

Material adverse change

Colorado precertification list change notification

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes 0738T and 0739T

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes Q4272 - Q4284

Prior AuthorizationMedicare AdvantageNovember 8, 2023

Prior authorization requirement changes effective May 1, 2024 

Code E0761

Prior AuthorizationCommercialFebruary 1, 2024

Material adverse change

Claims match enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing

Reimbursement PoliciesCommercialFebruary 1, 2024

Material adverse change

Reimbursement policy: Facility Guidelines for Claims Related to Professional Services – Facility update

Reimbursement PoliciesCommercialFebruary 1, 2024

Material adverse change

New reimbursement policy: Modifier Usage – Facility update

Products & Programs

PharmacyCommercialFebruary 1, 2024

Material adverse change

Prior authorization updates for specialty pharmacy

PharmacyMedicare AdvantageJanuary 18, 2024

RETRACTED: Expansion of specialty pharmacy precertification list

Quality Management

Quality ManagementMedicare AdvantageFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementCommercialFebruary 1, 2024

Improving Hispanic heart health

COBCBS-CRCM-048963-24