CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 1, 2023

October 2023 Provider Newsletter

Featured Articles

Digital SolutionsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 1, 2023

Availity PDM application is now the intake channel for all demographic change requests, including roster uploads

WebinarsCommercialMedicare AdvantageOctober 1, 2023

Looking to earn CME credits? Check out the CME Engagement Hub!

AdministrativeCommercialHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 1, 2023

Help your patients continue their care and navigate Medicaid renewal

Administrative

AdministrativeCommercialOctober 1, 2023

Enhanced outpatient facility editing for National Correct Coding Initiative: Medically Unlikely Edits (MUEs) 

AdministrativeCommercialOctober 1, 2023

CAA: Maintain your online provider directory information

AdministrativeHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 1, 2023

Clinical Laboratory Improvement Amendments

AdministrativeCommercialOctober 1, 2023

National Accounts 2024 Pre-certification list

Digital SolutionsMedicare AdvantageOctober 1, 2023

Personalized Match Phase 1

Digital SolutionsMedicare AdvantageOctober 1, 2023

Availity: Medicare provider-facing talking points and FAQ

Digital SolutionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 1, 2023

Improvements to Secure Messaging through Claims Status and Payer Spaces

Education & Training

Education & TrainingCommercialOctober 1, 2023

New website for cancer caregivers

WebinarsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingSeptember 22, 2023

You're invited: Thriving, not just surviving: Youth mental health in today's world

WebinarsMedicare AdvantageJune 30, 2023

Required training - Model of Care

Policy Updates

Policy UpdatesMedicare AdvantageSeptember 13, 2023

Clinical Criteria updates - June 2023

Medical Policy & Clinical GuidelinesCommercialOctober 1, 2023

Change to Prior Authorization Requirements

Transition to Carelon Medical Benefits Management, Inc. site of care guidelines

Medical Policy & Clinical GuidelinesCommercialOctober 1, 2023

Change to Prior Authorization Requirements

Medical Policies and Clinical Guidelines updates 

Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 7, 2023

Carelon Medical Benefits Management, Inc Spine & Joint Surgery Guideline Update

Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingSeptember 22, 2023

Prior authorization update

Reimbursement PoliciesMedicare AdvantageOctober 1, 2023

Genetic Tests: Once per Lifetime 

Reimbursement PoliciesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 1, 2023

Reimbursement policy update - Modifiers 25 and 57 

Products & Programs

Products & ProgramsCommercialOctober 1, 2023

Blue High Performance Network

PharmacyCommercialOctober 1, 2023

Change to Prior Authorization Requirements

Specialty pharmacy updates — October 2023

PharmacyMedicare AdvantageSeptember 19, 2023

Medicare Part B precert expansion: Adstiladrin, Altuviiio, Idacio, Lamzede, Lunsumio, Rebyota, Signifor LAR, Syfovre, and Vivimusta

PharmacyMedicare AdvantageSeptember 22, 2023

Medicare Part B precert expansion: Elfabrio, Epkinly, Qalsody, Vyjuvek, and Zynyz

INBCBS-CDCRCM-038799-23-CPN38706

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.