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State & FederalMedicare AdvantageMay 1, 2023

Genetic testing

State & FederalMedicare AdvantageMay 1, 2023

Did your patient have a recent fracture?

State & FederalMedicare AdvantageMarch 31, 2023

Keep up with Medicare News - April 2023
- Clinical Criteria Updates
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Imjudo, Pedmark, Tecvayli, Tzield, Vegzelma)
- Blue Cross and Blue Shield expands specialty pharmacy precertification list (Elahere)
- New specialty pharmacy medical step therapy requirements (Avastin, Byooviz, Cimerli, Eylea, Lucentis, Vabysmo)
- Genetic testing CPT code list update for Carelon Medical Benefits Management (formerly AIM Specialty Health)
- Clinical Criteria updates

State & FederalMedicare AdvantageMarch 31, 2023

E-visits

State & FederalMedicare AdvantageMarch 1, 2023

Keep up with Medicare News - March 2023
- Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List in Missouri
- Carelon Medical Benefits Management, Inc. Genetic Testing Clinical Appropriateness Guidelines CPT code list update
- What date to select for inpatient admissions for claims
- Clinical Criteria updates
- New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)
- Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines

State & FederalMedicare AdvantageMarch 1, 2023

Shared savings and transition care management after inpatient discharges

State & FederalMedicare AdvantageMarch 1, 2023

Informational Update Modifier Usage

State & FederalMedicare AdvantageMarch 1, 2023

Annual planned visits

State & FederalMedicare AdvantageJanuary 31, 2023

Keep up with Medicare News - February 2023
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Fylnetra)
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Spevigo, Xenpozyme)
- Specialty pharmacy precertification list expansion (Rolvedon, Stimufend)
- New specialty pharmacy medical step therapy requirements
- Prior authorization requirement changes effective April 1, 2023
- Medical Policies and Clinical Utilization Management Guidelines update

State & FederalMedicare AdvantageDecember 30, 2022

Keep up with Medicare news - January 2023
- Prior authorization requirement changes
- New specialty pharmacy medical step therapy requirements (Inflectra & Renflexis)
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Cimerli)
- Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines

State & FederalMedicare AdvantageDecember 30, 2022

Cleveland-Cliffs offers Medicare Advantage option

State & FederalMedicare AdvantageDecember 1, 2022

Keep up with Medicare News - December 2022
- Medical drug benefit Clinical Criteria updates
- Medical Policies and Clinical Utilization Management Guidelines update
- Signature requirements for laboratory orders or requisitions

State & FederalMedicare AdvantageDecember 1, 2022

2023 Medicare Advantage service area and benefit updates

State & FederalMedicare AdvantageDecember 1, 2022

Personal home helper benefit ending

State & FederalMedicare AdvantageNovember 1, 2022

Keep up with Medicare News - November 2022
- Medical drug benefit Clinical Criteria updates
- New specialty pharmacy medical step therapy requirements (Avastin, Mvasi)
- New specialty pharmacy medical step therapy requirements (Zarxio)

State & FederalMedicare AdvantageNovember 1, 2022

Personalized Match

State & FederalMedicare AdvantageNovember 1, 2022

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

State & FederalMedicare AdvantageOctober 1, 2022

Courtesy notification of specialty pharmacy medical step therapy updates

State & FederalMedicare AdvantageOctober 1, 2022

Keep up with Medicare News - October 2022
  • Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ
  • Anthem expands specialty pharmacy precertification list-1
  • Anthem expands specialty pharmacy precertification list-2
  • Consultation codes

State & FederalMedicare AdvantageSeptember 1, 2022

Enhancing claims attachment processes through digital applications

State & FederalMedicare AdvantageSeptember 1, 2022

Keep up with Medicare News - September 2022
- Anthem expands specialty pharmacy precertification list
- Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

 

State & FederalMedicare AdvantageSeptember 1, 2022

Prior authorization requirement changes effective December 1, 2022

State & FederalMedicare AdvantageSeptember 1, 2022

Anthem expands specialty pharmacy precertification list

State & FederalMedicare AdvantageSeptember 1, 2022

Reminder: AIM prior authorization phone number change for Medicare

State & FederalMedicare AdvantageAugust 1, 2022

Keep up with Medicare News - August 2022
- MCG care guidelines 26th edition

State & FederalMedicare AdvantageJuly 1, 2022

Cancer Care Navigator

State & FederalMedicare AdvantageJuly 1, 2022

Keep up with Medicare News - July 2022
- New specialty pharmacy medical step therapy requirements

State & FederalMedicare AdvantageJune 1, 2022

Medical policies and clinical utilization management guidelines update

State & FederalMedicare AdvantageJune 1, 2022

Medical drug benefit clinical criteria updates

State & FederalMedicare AdvantageJune 1, 2022

Evaluation and management services for COVID testing - professional

State & FederalMedicare AdvantageJune 1, 2022

Keep up with Medicare News - June 2022

State & FederalMedicare AdvantageMay 1, 2022

New specialty pharmacy medical step therapy requirements-March 2022 update

State & FederalMedicare AdvantageMay 1, 2022

Keep up with Medicare News - May 2022
- Anthem expands specialty pharmacy precertification list-March 2022 update
- Anthem expands specialty pharmacy precertification list-April 2022 update
- New specialty pharmacy medical step therapy requirements-May 2022 update

State & FederalMedicare AdvantageApril 1, 2022

Model of Care required training

State & FederalMedicare AdvantageApril 1, 2022

Evaluation and management documentation guidelines

State & FederalMedicare AdvantageApril 1, 2022

Clinical Criteria updates

State & FederalMedicare AdvantageApril 1, 2022

The impact of listening

State & FederalMedicare AdvantageApril 1, 2022

Reimbursement policy update: Inpatient readmissions

State & FederalMedicare AdvantageApril 1, 2022

Keep up with Medicare News - April 2022
- Medical Policies and Clinical Utilization Management Guidelines update
- AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates
- Anthem expands specialty pharmacy precertification list