CommercialMedicare AdvantageDecember 1, 2023

December 2023 Provider Newsletter

Featured Articles

Education & TrainingMedicare AdvantageDecember 1, 2023

Model of care training reminder

Administrative

AdministrativeMedicare AdvantageNovember 1, 2023

Updates to correct coding editing

AdministrativeCommercialDecember 1, 2023

New vendor administering Primary Care Access Survey

AdministrativeCommercialDecember 1, 2023

New vendor administering behavioral health access survey

AdministrativeCommercialDecember 1, 2023

Outpatient system updates for 2024

AdministrativeCommercialDecember 1, 2023

Professional system updates for 2024

AdministrativeCommercialDecember 1, 2023

Important information about utilization management

AdministrativeCommercialDecember 1, 2023

Notification about submitting itemized bills

AdministrativeCommercialMedicare AdvantageDecember 1, 2023

New requirements for credentialing and recredentialing

AdministrativeCommercialDecember 1, 2023

Case Management Program

AdministrativeCommercialDecember 1, 2023

Coordination of care

AdministrativeCommercialDecember 1, 2023

CAA: Review your online provider directory information

AdministrativeCommercialDecember 1, 2023

Clinical practice and preventive health guidelines

AdministrativeCommercialDecember 1, 2023

Members’ Rights and Responsibilities

Digital SolutionsCommercialDecember 1, 2023

Clinical Documentation Lookup Tool

Digital SolutionsCommercialNovember 21, 2023

Process for Carelon Post Acute Solutions, LLC redirection and Availity Essentials clinical denial/approval outcome notifications

Policy Updates

Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 21, 2023

Medical Policies and Clinical Utilization Management Guidelines update for May 2023

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2023

Medical Policies and Clinical Guidelines updates — December 2023

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2023

Medical Policies and Clinical Guidelines updates — December 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 1, 2023

Glucagon-Like Peptide-1 prior authorization changes

Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 20, 2023

Transition to Carelon Medical Benefits Management, Inc. Genetic Testing Guidelines

Medical Policy & Clinical GuidelinesCommercialOctober 27, 2023

Transition to Carelon Medical Benefits Management, Inc. Genetic Testing Guidelines

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

Prior AuthorizationMedicare AdvantageNovember 8, 2023

Prior authorization requirement changes effective May 1, 2024 

Code E0761

Prior AuthorizationMedicare AdvantageOctober 31, 2023

Prior authorization requirement changes effective March 1, 2024 

Codes 33275 and 33274

Products & Programs

Products & ProgramsCommercialDecember 1, 2023

Introducing the High Performing Provider designation

Federal Employee Program (FEP)CommercialDecember 1, 2023

Federal Employee Program updates member ID cards

Federal Employee Program (FEP)Medicare AdvantageDecember 1, 2023

2024 Federal Employee Program Benefit information available online

PharmacyCommercialNovember 1, 2023

Pharmacy information available on our provider website

PharmacyMedicare AdvantageOctober 26, 2023

Notification of specialty pharmacy medical step therapy updates

Quality Management

Quality ManagementCommercialMedicare AdvantageNovember 13, 2023

HEDIS 2023 Electronic Clinical Data Systems (ECDS)

MOBCBS-CRCM-045272-23

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