CommercialMedicare AdvantageAugust 1, 2024

August 2024 Provider Newsletter

Featured Articles

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

MCG Care Guidelines 28th edition


Administrative

AdministrativeCommercialAugust 1, 2024

Incidental services — facility editing update

AdministrativeCommercialAugust 1, 2024

Device-dependent procedures — facility editing update

AdministrativeMedicare AdvantageAugust 1, 2024

ICD-10-CM Excludes1 notes

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 GuidelinesCommercialJune 25, 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 GuidelinesMedicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

Material adverse change

Medical Policies and Clinical Guidelines updates

Prior AuthorizationCommercialAugust 1, 2024

Notification of authorization fax number changes

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

New reimbursement policy: Intraoperative Neuromonitoring — Professional

Reimbursement PoliciesCommercialAugust 1, 2024

Reimbursement policy update: Modifiers 26 and TC —Professional

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Bundled Services and Supplies — Facility

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

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

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

PharmacyCommercialJuly 25, 2024

Material adverse change

Specialty pharmacy updates — February 2024

Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.

PharmacyCommercialAugust 1, 2024

Material adverse change

Specialty pharmacy updates — August 2024

Tevimbra, Tyenne, and Wezlana

PharmacyCommercialAugust 1, 2024

Material adverse change

Clinical Criteria updates for specialty pharmacy are available

GABCBS-CRCM-063088-24