CommercialMedicare AdvantageMay 31, 2023

June 2023 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageMay 31, 2023

Introducing Roster Automation to improve turnaround times and data accuracy

Federal Employee Program (FEP)CommercialMay 31, 2023

Correction: Federal Employee Program® Quality Reimbursement program update


Administrative

AdministrativeCommercialMedicare AdvantageMay 23, 2023

Implementation of the new strategic provider system

Digital SolutionsCommercialMay 31, 2023

Digital notifications are coming June 1, 2023

Education & Training

Education & TrainingCommercialMay 31, 2023

Building Vaccine Confidence – A webinar hosted by Pfizer

Policy Updates

Policy UpdatesMedicare AdvantageMay 31, 2023

MCG Care Guidelines 27th Edition

Policy UpdatesCommercialMay 31, 2023

HCPCS to revenue code alignment – Evaluation/Management

Policy UpdatesCommercialMay 22, 2023

Material adverse change

MCG Care Guidelines 27th Edition

Policy UpdatesMedicare AdvantageMay 11, 2023

Clinical Criteria Updates February 2023

Medical Policy & Clinical GuidelinesCommercialMay 31, 2023

Medical Policy and Clinical Utilization Management Guidelines update (MAC)
Material adverse change (MAC)

Prior AuthorizationMedicare AdvantageMay 31, 2023

Medicare Part B Step Therapy Vegzelma

Prior AuthorizationMedicare AdvantageMay 31, 2023

Medicare Part B Precert Expansion Briumvi Leqembi

Reimbursement PoliciesCommercialMay 31, 2023

Reimbursement policy update: Bundled Services and Supplies Policy – Professional (MAC)
Material adverse change (MAC)

Reimbursement PoliciesCommercialMay 31, 2023

New reimbursement policy: Provider Preventable Conditions – Professional and Facility (MAC)
Material adverse change (MAC)

Reimbursement PoliciesCommercialMay 31, 2023

Reimbursement policy update: Bundled Services and Supplies — Professional

Products & Programs

Products & ProgramsCommercialMay 31, 2023

Expansion of Back Pain Guide Program effective July 1, 2023

Federal Employee Program (FEP)CommercialMay 31, 2023

OBRA 93 claim filing for Federal Employee Program

PharmacyCommercialMarch 1, 2023

Pharmacy information available on our provider website

PharmacyCommercialMay 31, 2023

Specialty pharmacy updates – June 2023 (MAC)
Material adverse change (MAC)

PharmacyCommercialMay 31, 2023

BioPlus provider FAQ

Quality Management

Quality ManagementCommercialMedicare AdvantageMay 31, 2023

Patient Safety Skilled Nursing Facility (SNF) Survey

Quality ManagementMedicare AdvantageMay 2, 2023

Colorectal Cancer Screening (COL) and Care for Older Adults (COA) for HEDIS

Quality ManagementMedicare AdvantageMay 22, 2023

SPC Exclusions

COBCBS-CRCM-024888-23

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. BioPlus Specialty Pharmacy is an independent company providing pharmacy services on behalf of the health plan.