February 1, 2024

February 2024 Provider Newsletter

Administrative

AdministrativeCommercialFebruary 1, 2024

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

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 & TrainingMedicaidFebruary 1, 2024

Provider Pathways — Learn all about it

Policy Updates

Policy UpdatesMedicare AdvantageJanuary 18, 2024

Clinical Criteria updates — September 2023

Policy UpdatesCommercialFebruary 1, 2024

MCG care guidelines 27th edition update

Medical Policy & Clinical GuidelinesCommercialJanuary 24, 2024

Carelon Medical Benefits Management, Inc. genetic testing code updates

Medical Policy & Clinical GuidelinesMedicaidJanuary 5, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Prior AuthorizationCommercialFebruary 1, 2024

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

Prior AuthorizationMedicaidDecember 26, 2023

Prior authorization requirement changes effective February 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

New reimbursement policy: Modifier Usage — Facility

Reimbursement PoliciesCommercialFebruary 1, 2024

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

Products & Programs

PharmacyCommercialJanuary 24, 2024

Specialty pharmacy updates — February 2024

PharmacyMedicare AdvantageJanuary 18, 2024

RETRACTED: Expansion of specialty pharmacy precertification list

Quality Management

Quality ManagementMedicare AdvantageFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementCommercialFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementMedicaidFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementMedicaidFebruary 1, 2024

HEDIS measurement year 2023 documentation for Transitions of Care (TRC)

KYBCBS-CDCRCM-048967-24

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