Notice of Material Changes/Amendments to Contract and Prior Authorization Changes: February 2019

Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

 

• Medical Policy/Clinical Guidelines Updates – February 2019*

 

• Reimbursement Policy Updates – February 2019*

 

• Clinical criteria updates for specialty pharmacy*

 

• Specialty pharmacy prior authorization list expansion*

 

• Specialty pharmacy medical step therapy drug list expansion*

 

• Professional billing - Update regarding E/M with modifier 25

 

• Medicare and Medicaid updates