October 1, 2023

October 2023 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid

Featured Articles

WebinarsCommercialMedicare AdvantageOctober 1, 2023

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

Administrative

AdministrativeCommercialOctober 1, 2023

National Accounts 2024 Pre-certification list

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

AdministrativeMedicaidSeptember 15, 2023

Notice to ancillary providers who bill medical/pharmacy charges 

AdministrativeMedicaidOctober 1, 2023

Reminder: Appointment availability and after-hours access requirements

Digital SolutionsMedicare AdvantageOctober 1, 2023

Personalized Match Phase 1

Digital SolutionsMedicare AdvantageOctober 1, 2023

Availity: Medicare provider-facing talking points and FAQ

Digital SolutionsCommercialMedicare AdvantageMedicaidOctober 1, 2023

Improvements to Secure Messaging through Claims Status and Payer Spaces

Education & Training

Education & TrainingCommercialOctober 1, 2023

New website for cancer caregivers

WebinarsCommercialMedicare AdvantageSeptember 22, 2023

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

WebinarsCommercialMedicare AdvantageMedicaidSeptember 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 UpdatesMedicaidSeptember 5, 2023

Clinical Criteria updates - May 2023

Policy UpdatesMedicare AdvantageSeptember 13, 2023

Clinical Criteria updates - June 2023

Medical Policy & Clinical GuidelinesCommercialOctober 1, 2023

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

Medical Policy & Clinical GuidelinesCommercialOctober 1, 2023

Medical Policies and Clinical Guidelines updates 

Prior AuthorizationMedicaidSeptember 13, 2023

Prior authorization requirement changes effective November 1, 2023

Reimbursement PoliciesCommercialOctober 1, 2023

Reimbursement policy update: After-Hours, Emergency, and Miscellaneous E/M Services – Professional

Reimbursement PoliciesMedicare AdvantageOctober 1, 2023

Genetic Tests: Once per Lifetime 

Products & Programs

PharmacyCommercialOctober 1, 2023

Specialty pharmacy updates — October 2023

PharmacyMedicare AdvantageSeptember 22, 2023

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

PharmacyMedicare AdvantageSeptember 19, 2023

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

PharmacyMedicaidSeptember 14, 2023

Notice of Material Amendment to Healthcare Contract: Prior authorization updates for medications billed under the medical benefit 

Quality Management

Quality ManagementCommercialMedicare AdvantageMedicaidAugust 29, 2023

Pharmacotherapy Management of COPD Exacerbation HEDIS

KYBCBS-CDCRCM-038800-23-CPN38706

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