CommercialMedicare AdvantageNovember 1, 2023

November 2023 Provider Newsletter

Featured Articles

Digital SolutionsCommercialOctober 31, 2023

Digital RFAI process improvements

Education & TrainingCommercialOctober 31, 2023

Practitioners’ rights during credentialing process

Administrative

AdministrativeMedicare AdvantageNovember 1, 2023

Updates to correct coding editing

AdministrativeMedicare AdvantageOctober 31, 2023

2024 Medicare Advantage service area and benefit updates

AdministrativeMedicare AdvantageNovember 1, 2023

Usage of liability modifiers

AdministrativeCommercialNovember 1, 2023

CAA: Maintain your online provider directory information

Digital SolutionsCommercialNovember 1, 2023

Filing digital claims disputes: Transparent and trackable

Digital SolutionsCommercialMedicare AdvantageOctober 31, 2023

Changes to our data management system help streamline your demographic update process

Policy Updates

Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 1, 2023

Carelon Medical Benefits Management, Inc. updates — November 2023

Prior AuthorizationMedicare AdvantageOctober 16, 2023

RETRACTION: Prior authorization requirement changes effective February 1, 2024

Codes 32274 and 32275

Prior AuthorizationMedicare AdvantageOctober 3, 2023

Prior authorization requirement changes effective February 1, 2024 - code J1411

Prior AuthorizationMedicare AdvantageOctober 19, 2023

Expansion of Carelon Medical Benefits Management, Inc. programs

Reimbursement PoliciesCommercialOctober 31, 2023

Reimbursement policy update: Pharmaceutical Waste – Professional and Facility

Products & Programs

Federal Employee Program (FEP)CommercialOctober 31, 2023

Material adverse change

Prior authorization updates for specialty pharmacy

Federal Employee Program (FEP)CommercialOctober 31, 2023

Material adverse change

Federal Employee Program specialty pharmacy prior authorization review

PharmacyCommercialOctober 31, 2023

Material adverse change

Prior authorization updates for specialty pharmacy

PharmacyCommercialNovember 1, 2023

Pharmacy information available on our provider website

Quality Management

Quality ManagementCommercialMedicare AdvantageOctober 25, 2023

HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS)

Quality ManagementMedicare AdvantageNovember 1, 2023

Controlling high blood pressure and HEDIS

Quality ManagementCommercialMedicare AdvantageSeptember 27, 2023

Be Antibiotics Aware: Protect your patients

Quality ManagementCommercialMedicare AdvantageOctober 15, 2023

HEDIS medical record submission made easier with our Remote EMR Access Service

Quality ManagementCommercialMedicare AdvantageNovember 1, 2023

HEDIS measurement year 2023 documentation for Transitions of Care (TRC)

Quality ManagementMedicare AdvantageNovember 1, 2023

Statin therapy end of year best practices

COBCBS-CRCM-041559-23

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