CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 1, 2024

February 2024 Provider Newsletter

Administrative

AdministrativeCommercialFebruary 1, 2024

CAA: Have you reviewed your online provider directory information lately?

AdministrativeHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 1, 2024

Inappropriate primary diagnosis

Digital SolutionsCommercialFebruary 1, 2024

RETRACTED: Beginning in March 2024, you can submit Behavioral Health prior authorizations through the Authorization application on Availity.com

Digital SolutionsCommercialFebruary 1, 2024

Update: Training for digital requests for additional information (Digital RFAI)

Education & Training

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 1, 2024

Provider Pathways — Learn all about it

Policy Updates

Policy UpdatesCommercialFebruary 1, 2024

Change to Prior Authorization Requirements

MCG care guidelines 27th edition update

Policy UpdatesMedicare AdvantageJanuary 18, 2024

Clinical Criteria updates — September 2023

Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 18, 2024

Prior authorization update

Medical Policy & Clinical GuidelinesCommercialJanuary 24, 2024

Change to Prior Authorization Requirements

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationCommercialFebruary 1, 2024

Change to Prior Authorization Requirements

Claims Match Enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing

Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 11, 2024

Prior authorization requirement changes effective March 1, 2024

Prior AuthorizationMedicare AdvantageNovember 8, 2023

Prior authorization requirement changes effective May 1, 2024 

Code E0761

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes 0738T and 0739T

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes Q4272 - Q4284

Reimbursement PoliciesCommercialFebruary 1, 2024

Change to Prior Authorization Requirements

New reimbursement policy: Modifier Usage — Facility

Reimbursement PoliciesCommercialFebruary 1, 2024

Change to Prior Authorization Requirements

Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

Products & Programs

PharmacyMedicare AdvantageJanuary 18, 2024

RETRACTED: Expansion of specialty pharmacy precertification list

PharmacyCommercialJanuary 24, 2024

Change to Prior Authorization Requirements

Specialty pharmacy updates — February 2024

Quality Management

Quality ManagementMedicare AdvantageFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementCommercialFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 1, 2024

Controlling high blood pressure and HEDIS

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingDecember 27, 2023

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

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 3, 2024

HEDIS 2023 Electronic Clinical Data Systems

INBCBS-CDCRCM-048966-24

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