CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 1, 2024
August 2024 Provider Newsletter
Featured Articles
CommercialAugust 1, 2024
Change to Prior Authorization Requirements
New reimbursement policy: Intraoperative Neuromonitoring — Professional
Medicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 1, 2024
Admission, discharge, and transfer information is now available for Medicare Advantage and Medicaid members
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 notesCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 3, 2024
Phoenix Sepsis Criteria for coding and billing pediatric sepsisMedicare AdvantageJuly 16, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialJuly 24, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialAugust 1, 2024
Coming soon: View your fee schedule in Availity Essentials Payer SpacesBehavioral Health
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 16, 2024
Correct billing of mobile crisis servicesEducation & Training
CommercialMedicare AdvantageAugust 1, 2024
August is National Breastfeeding MonthPolicy Updates
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 31, 2024
Facility emergency department leveling reviews for providers under investigationCommercialJune 25, 2024
Change to Prior Authorization Requirements
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
CommercialAugust 1, 2024
MCG Care Guidelines 28th editionCommercialJuly 11, 2024
Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — August 2024Medicare 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
Change to Prior Authorization Requirements
Reimbursement policy update: Bundled Services and Supplies — FacilityCommercialAugust 1, 2024
Change to Prior Authorization Requirements
Reimbursement policy update: Professional Anesthesia ServiceMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Modifier 78CommercialAugust 1, 2024
Reimbursement policy update: Modifiers 26 and TC — ProfessionalCommercialAugust 1, 2024
Change to Prior Authorization Requirements
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
Change to Prior Authorization Requirements
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
Change to Prior Authorization Requirements
Specialty pharmacy updates — August 2024Tevimbra, Tyenne, and Wezlana
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 23, 2024
Prior authorization updates for medications billed under the medical benefitByooviz
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 11, 2024
Prior authorization updates for medications billed under the medical benefitQalsody and Zynyz
INBCBS-CDCRCM-063090-24
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