CommercialMedicare AdvantageAugust 1, 2024
August 2024 Provider Newsletter
Featured Articles
CommercialAugust 1, 2024
MCG Care Guidelines 28th edition
Administrative
CommercialAugust 1, 2024
CAA: Providers required to verify their online provider directory informationCommercialAugust 1, 2024
Incidental services — facility editing updateCommercialAugust 1, 2024
Device-dependent procedures — facility editing updateMedicare AdvantageAugust 1, 2024
ICD-10-CM Excludes1 notesCommercialJuly 24, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsMedicare AdvantageJuly 16, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialAugust 1, 2024
Coming soon: View your fee schedule in Availity Essentials Payer SpacesMedicare AdvantageJuly 9, 2024
Coming soon — digital-only authorization case status notifications for MedicareEducation & Training
CommercialMedicare AdvantageAugust 1, 2024
Coming soon: Provider e-Learning Resource Center for Payment IntegrityCommercialMedicare AdvantageAugust 1, 2024
August is National Breastfeeding MonthPolicy Updates
CommercialJune 25, 2024
Material adverse change
Updates to Carelon Medical Benefits Management Clinical Appropriateness GuidelinesMedicare AdvantageJuly 11, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective for dates of service on and after November 17, 2024
Medicare AdvantageJuly 5, 2024
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 8, 2024
CommercialAugust 1, 2024
Notification of authorization fax number changesCommercialAugust 1, 2024
Material adverse change
New reimbursement policy: Intraoperative Neuromonitoring — ProfessionalCommercialAugust 1, 2024
Reimbursement policy update: Modifiers 26 and TC —ProfessionalCommercialAugust 1, 2024
Material adverse change
Reimbursement policy update: Bundled Services and Supplies — FacilityMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Modifier 78CommercialAugust 1, 2024
Material adverse change
Reimbursement policy update: Outpatient Facility Revenue Code Billing Requirements — FacilityMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant ServicesProducts & Programs
CommercialJuly 25, 2024
Material adverse change
Specialty pharmacy updates — February 2024Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.
CommercialAugust 1, 2024
Material adverse change
Specialty pharmacy updates — August 2024Tevimbra, Tyenne, and Wezlana
CommercialAugust 1, 2024
Material adverse change
Clinical Criteria updates for specialty pharmacy are availableGABCBS-CRCM-063088-24
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