CommercialMedicare AdvantageSeptember 1, 2023

September 2023 Provider Newsletter

Featured Articles

AdministrativeCommercialSeptember 1, 2023

HCPCS to revenue code alignment

Administrative

AdministrativeCommercialSeptember 1, 2023

Update — Enhanced outpatient facility editing for National Correct Coding Initiative

AdministrativeCommercialSeptember 1, 2023

CAA: Have you reviewed your online provider directory information lately?

AdministrativeCommercialSeptember 1, 2023

Support documentation for Carelon Medical Benefits Management, Inc. prior authorization requests

Digital SolutionsCommercialSeptember 1, 2023

Improvements to Digital RFAI Attachment filtering and reporting

Digital SolutionsMedicare AdvantageSeptember 1, 2023

Personalized match phase 1: Specialist provider overview

Digital SolutionsCommercialSeptember 1, 2023

Simplifying claims attachments: Digital Request for Additional Information through Availity.com

Digital SolutionsCommercialSeptember 1, 2023

Member search feature enhancement: Search for a patient without using member ID in Availity Essentials

Education & Training

Education & TrainingCommercialMedicare AdvantageJuly 10, 2023

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

Policy Updates

Policy UpdatesMedicare AdvantageAugust 14, 2023

Clinical Criteria updates - May 2023

Medical Policy & Clinical GuidelinesCommercialSeptember 1, 2023

Medical policies and clinical guidelines updates - September 2023

Medical Policy & Clinical GuidelinesCommercialSeptember 1, 2023

Medical policies and clinical guidelines moving to pre-cert

Medical Policy & Clinical GuidelinesCommercialSeptember 1, 2023

Medical policies and clinical guidelines updates

Prior AuthorizationMedicare AdvantageAugust 7, 2023

Prior authorization requirement changes effective December 1, 2023

Prior AuthorizationCommercialMedicare AdvantageJune 9, 2023

Carelon Medical Benefits Management, Inc. advanced imaging — Imaging of the brain CPT code list update

Reimbursement PoliciesCommercialSeptember 1, 2023

Reimbursement policy update: Documentation Standards for Episodes of Care - Professional

Reimbursement PoliciesCommercialSeptember 1, 2023

Clarification to reimbursement policy update: Prolonged Services – Professional

Reimbursement PoliciesCommercialSeptember 1, 2023

Reimbursement policy update: Documentation and Reporting Guidelines for Evaluation and Management Services - Professional

Reimbursement PoliciesCommercialSeptember 1, 2023

Reimbursement policy update: Place of Service – Facility

Reimbursement PoliciesCommercialSeptember 1, 2023

New reimbursement policy: Split Care Surgical Modifiers — Professional

Products & Programs

PharmacyCommercialSeptember 1, 2023

Specialty pharmacy updates – September 2023

PharmacyCommercialSeptember 1, 2023

Sublocade® update

PharmacyMedicare AdvantageAugust 3, 2023

Specialty pharmacy medical step therapy for hyaluronan injections

PharmacyMedicare AdvantageJuly 28, 2023

UPDATED: Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

Quality Management

Quality ManagementMedicare AdvantageSeptember 1, 2023

Medication reconciliation post inpatient discharge

MOBCBS-CRCM-035543-23

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. Availity, LLC is an independent company providing administrative support services on behalf of the health plan.