November 1, 2023
November 2023 Provider Newsletter
Featured Articles
MedicaidOctober 31, 2023
Statin Therapy Exclusions for Patients With Cardiovascular HEDIS measures
CommercialNovember 1, 2023
Digital RFAI process improvements
Administrative
Medicare AdvantageOctober 31, 2023
2024 Medicare Advantage service area and benefit updatesMedicare AdvantageNovember 1, 2023
Updates to correct coding editingMedicare AdvantageNovember 1, 2023
Usage of liability modifiersCommercialNovember 1, 2023
CAA: Maintain your online provider directory informationCommercialNovember 1, 2023
Filing digital claims disputes: Transparent and trackableCommercialMedicare AdvantageMedicaidOctober 31, 2023
A way to help lower-income patients pay for internet servicePolicy Updates
MedicaidOctober 18, 2023
Clinical Criteria updates - June 2023CommercialNovember 1, 2023
Medical Policies and Clinical Guidelines updates — November 2023Medicare AdvantageNovember 1, 2023
Carelon Medical Benefits Management, Inc. updates — November 2023Medicare AdvantageOctober 19, 2023
Expansion of Carelon Medical Benefits Management, Inc. programsMedicaidOctober 16, 2023
Medical Prior Authorization Update Fylnetra, Rolvedon, StimufendMedicaidOctober 16, 2023
Fylnetra, Stimufend, Rolvedon Medical Step Therapy NoticeMedicare AdvantageOctober 16, 2023
RETRACTION: Prior authorization requirement changes effective February 1, 2024Codes 32274 and 32275
CommercialSeptember 28, 2023
Expansion of Carelon Medical Benefits Management, Inc. programs, effective April 1, 2024Medicare AdvantageOctober 3, 2023
Prior authorization requirement changes effective February 1, 2024 - code J1411CommercialOctober 31, 2023
Reimbursement policy update: Pharmaceutical Waste – Professional and FacilityMedicaidOctober 31, 2023
Genetic Tests: Once per LifetimeProducts & Programs
CommercialNovember 1, 2023
Federal Employee Program specialty pharmacy prior authorization reviewCommercialNovember 1, 2023
FEP® Specialty Pharmacy prior authorization listCommercialNovember 1, 2023
Specialty pharmacy updatesMedicaidOctober 10, 2023
Prior Authorization Update - AltuviiioCommercialNovember 1, 2023
Pharmacy information available on our provider websiteQuality Management
Medicare AdvantageNovember 1, 2023
Controlling high blood pressure and HEDISCommercialMedicare AdvantageOctober 25, 2023
HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS)CommercialMedicare AdvantageNovember 1, 2023
HEDIS measurement year 2023 documentation for Transitions of Care (TRC)CommercialMedicare AdvantageOctober 15, 2023
HEDIS medical record submission made easier with our Remote EMR Access ServiceCommercialMedicare AdvantageSeptember 27, 2023
Be Antibiotics Aware: Protect your patientsMedicare AdvantageNovember 1, 2023
Statin therapy end of year best practicesKYBCBS-CDCRCM-041563-23
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