July 1, 2024

July 2024 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid

Administrative

AdministrativeMedicaidJune 13, 2024

Therapeutic Rehabilitation Program services — H2019/H2020

AdministrativeCommercialJuly 1, 2024

Anesthesia modifiers — professional editing update

AdministrativeCommercialJuly 1, 2024

Provider manual updates to become effective October 1, 2024

AdministrativeCommercialJuly 1, 2024

Drugs and biologic

AdministrativeCommercialJuly 1, 2024

CAA: Maintain your online provider directory information

AdministrativeMedicare AdvantageMedicaidJuly 1, 2024

Inaccurate laterality and diagnosis combination

AdministrativeCommercialMedicare AdvantageMedicaidJune 12, 2024

Phoenix Sepsis Criteria for coding and billing pediatric sepsis

Digital SolutionsCommercialJune 20, 2024

Digital-only authorization case status notification coming to you

Digital SolutionsCommercialMedicare AdvantageMedicaidJuly 1, 2024

Digital Request for Additional Information is now available for all lines of business

Education & Training

Education & TrainingCommercialJune 13, 2024

Faster notification of EDI corrected claims errors

Education & TrainingCommercialMedicare AdvantageJuly 1, 2024

July is Disability Awareness Month

Policy Updates

Policy UpdatesMedicare AdvantageJune 4, 2024

Clinical Criteria updates

Effective July 6, 2024

Policy UpdatesMedicaidJune 5, 2024

Clinical Criteria updates 

Effective July 7, 2024

Policy UpdatesMedicare AdvantageJune 3, 2024

Clinical Criteria updates — November 2023

Policy UpdatesMedicare AdvantageMay 29, 2024

Carelon Medical Benefits Management, Inc. updates

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageJune 27, 2024

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

Medical Policy & Clinical GuidelinesCommercialJune 11, 2024

Medical Policies and Clinical Guidelines updates for July 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageMay 30, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2024

Medical Policy & Clinical GuidelinesMedicaidJune 7, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 14, 2024

Prior AuthorizationCommercialJune 19, 2024

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationMedicaidJune 17, 2024

Prior authorization requirement changes

Effective August 1, 2024

Products & Programs

Federal Employee Program (FEP)CommercialJuly 1, 2024

Antidepressant Medication Management (AMM)

PharmacyMedicaidJune 18, 2024

Prior authorization updates for medications billed under the medical benefit

Elrexfio, Ngenla, Pombiliti, Talvey, Tyruko, Veopoz, and Ycanth

PharmacyMedicaidJune 20, 2024

Prior authorization updates for medications billed under the medical benefit

Columvi, Izervay, Rystiggo, Vyvgart Hytrulo, and Eylea HD

PharmacyMedicare AdvantageJune 20, 2024

Anthem expands specialty pharmacy precertification list

PharmacyCommercialJuly 1, 2024

Correction: Specialty pharmacy updates — July 2024

Quality Management

Quality ManagementMedicare AdvantageJuly 1, 2024

Understanding your role in the Health Outcomes Survey

Quality ManagementMedicaidJuly 1, 2024

Complex Case Management program

Quality ManagementMedicaidJuly 1, 2024

Members’ Rights and Responsibilities section

Quality ManagementMedicaidJuly 1, 2024

Important information about utilization management

Quality ManagementCommercialMedicaidJune 3, 2024

Tips to Improve Adolescent Immunization (IMA) Rates

Quality ManagementCommercialMedicare AdvantageMedicaidJuly 1, 2024

New resources to improve your HEDIS® and CAHPS® quality rates

Quality ManagementMedicaidJune 6, 2024

HEDIS® 2024 documentation for Colorectal Cancer Screening (COL-E)

KYBCBS-CDCRCM-061274-24

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