CommercialMedicare AdvantageJuly 1, 2024

July 2024 Provider Newsletter

Featured Articles

AdministrativeCommercialJuly 1, 2024

Material adverse change

Fee schedule change notification letter


Administrative

AdministrativeCommercialJuly 1, 2024

Material adverse change

Drugs and biologic update

AdministrativeCommercialJuly 1, 2024

Anesthesia modifiers — professional editing update

AdministrativeCommercialJuly 1, 2024

Recovery room — facility editing update

AdministrativeCommercialMedicare AdvantageJune 12, 2024

Phoenix Sepsis Criteria for coding and billing pediatric sepsis

AdministrativeCommercialJuly 1, 2024

Address change for claims submissions and correspondence

AdministrativeCommercialJuly 1, 2024

CAA: Maintain your online provider directory information

AdministrativeCommercialJuly 1, 2024

CMS drug fee schedule update — third quarter 2024

Digital SolutionsCommercialJune 20, 2024

Digital-only authorization case status notification coming to you

Education & Training

Education & TrainingCommercialJune 13, 2024

Faster notification of EDI corrected claims errors

Education & TrainingCommercialMedicare AdvantageJuly 1, 2024

July is Disability Awareness Month

Policy Updates

Policy UpdatesMedicare AdvantageMay 29, 2024

Carelon Medical Benefits Management, Inc. updates

Policy UpdatesMedicare AdvantageJune 4, 2024

Clinical Criteria updates

Effective July 6, 2024

Policy UpdatesMedicare AdvantageJune 3, 2024

Clinical Criteria updates — November 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageMay 30, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2024

Medical Policy & Clinical GuidelinesCommercialJuly 1, 2024

Material adverse change

Medical Policy and Clinical Utilization Management (UM) Guidelines update

Medical Policy & Clinical GuidelinesCommercialJuly 1, 2024

Material adverse change

Medical Policy and Clinical Utilization Management Guidelines Notification letter

Medical Policy & Clinical GuidelinesCommercialJuly 1, 2024

Material adverse change

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

Medical Policy & Clinical GuidelinesMedicare AdvantageJune 21, 2024

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

Prior AuthorizationCommercialJuly 1, 2024

Material adverse change

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationCommercialJuly 1, 2024

Material adverse change

Expansion of Carelon Medical Benefits Management, Inc. programs

Prior AuthorizationCommercialJuly 1, 2024

Material adverse change

Colorado precertification list change notification July 1, 2024

Reimbursement PoliciesCommercialJuly 1, 2024

Material adverse change

Reimbursement policy update: Frequency Editing — Professional

Products & Programs

Federal Employee Program (FEP)CommercialJuly 1, 2024

Antidepressant Medication Management (AMM)

PharmacyMedicare AdvantageJune 20, 2024

Anthem expands specialty pharmacy precertification list

PharmacyCommercialJuly 1, 2024

Material adverse change

Updates for specialty pharmacy

Quality Management

Quality ManagementMedicare AdvantageJuly 1, 2024

Understanding your role in the Health Outcomes Survey

COBCBS-CRCM-061266-24