CommercialMedicare AdvantageMedicaidDecember 1, 2024

December 2024 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 14, 2024

Maximizing care with regular provider data attestation

Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality


Administrative

AdministrativeCommercialDecember 1, 2024

Case Management program

AdministrativeMedicare AdvantageMedicaidDecember 1, 2024

Drug and biologic

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

AdministrativeCommercialDecember 1, 2024

Coordination of care

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

AdministrativeCommercialDecember 1, 2024

Important information about utilization management

AdministrativeMedicare AdvantageNovember 18, 2024

Nevada 2025 Medicare Advantage plan changes

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

AdministrativeCommercialMedicare AdvantageDecember 1, 2024

Quest Diagnostics joins our network on January 1

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

Digital SolutionsMedicaidNovember 14, 2024

Advancing digital efficiency by discontinuing paper remittances

Behavioral Health

Behavioral HealthMedicaidNovember 11, 2024

Nevada expanded applied behavioral analysis services to all ages

Education & Training

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

Policy Updates

Policy UpdatesMedicaidNovember 15, 2024

Carelon Medical Benefits Management, Inc. updates

Effective December 18, 2024

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Policy UpdatesMedicaidNovember 7, 2024

Clinical Criteria update

Effective December 11, 2024

Policy UpdatesMedicaidNovember 15, 2024

Clinical Criteria updates

Effective December 18, 2024

Medical Policy & Clinical GuidelinesMedicaidNovember 14, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective December 15, 2024

Reimbursement PoliciesCommercialDecember 1, 2024

Material adverse change

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services — Professional

Reimbursement PoliciesCommercialDecember 1, 2024

Material adverse change

New reimbursement policy: Trauma Activation — Facility

Products & Programs

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Federal Employee Program (FEP)CommercialDecember 1, 2024

FEP excited to join PSHB program in 2025

PharmacyCommercialNovember 18, 2024

Material adverse change

Specialty pharmacy updates — December 2024

PharmacyCommercialDecember 1, 2024

Pharmacy information available online

PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

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