CommercialMedicare AdvantageMedicaidAugust 1, 2024
August 2024 Provider Newsletter
Featured Articles
CommercialAugust 1, 2024
MCG Care Guidelines 28th edition
Medicare AdvantageMedicaidAugust 1, 2024
Admission, discharge, and transfer information is now available for Medicare Advantage and Medicaid members
Administrative
Medicare AdvantageAugust 1, 2024
ICD-10-CM Excludes1 notesMedicaidJuly 17, 2024
Claim rejection noticeCommercialAugust 1, 2024
CAA: Providers required to verify their online provider directory informationMedicaidAugust 1, 2024
Rate change for after-hours CPT code 99050MedicaidAugust 1, 2024
Anatomical modifiersCommercialJuly 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 SpacesEducation & Training
CommercialMedicare AdvantageAugust 1, 2024
August is National Breastfeeding MonthPolicy Updates
MedicaidJuly 31, 2024
Facility emergency department leveling reviews for providers under investigationMedicaidJuly 8, 2024
Clinical Criteria updates — November 2023MedicaidAugust 1, 2024
New lab testing and clinical guidelines for AnthemCommercialJuly 11, 2024
Medical Policies and Clinical Guidelines updates — August 2024MedicaidJuly 17, 2024
Updates to Carelon Medical Benefits Management, Inc. 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
CommercialJune 25, 2024
Updates to Carelon Medical Benefits Management Clinical Appropriateness GuidelinesMedicare 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
New reimbursement policy: Intraoperative Neuromonitoring — ProfessionalMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Modifier 78CommercialAugust 1, 2024
Reimbursement policy update: Modifiers 26 and TC — ProfessionalCommercialAugust 1, 2024
Reimbursement policy update: Professional Anesthesia ServiceCommercialAugust 1, 2024
Reimbursement policy update: Bundled Services and Supplies — FacilityCommercialAugust 1, 2024
Reimbursement policy update: Outpatient Facility Revenue Code Billing Requirements — FacilityMedicaidAugust 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant ServicesMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant ServicesProducts & Programs
CommercialJuly 25, 2024
Specialty pharmacy updates — February 2024Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.
MedicaidJune 26, 2024
Prior authorization updates for medications billed under the medical benefitQuality Management
MedicaidAugust 1, 2024
Controlling high blood pressure and HEDISKYBCBS-CDCRCM-063091-24
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