Provider materials that formerly included the Carelon Post Acute Solutions name, such as determination letters and provider forms, have adopted the new name. However, there will be no changes in the way you submit a case nor to the contact information you use for checking case status.

Please see below for a list of FAQ. Additional questions can be directed to our Health Care Networks team using the contact information below:

Home health providers: HHprovider_relations@carelon.com
Post-acute institutional management (PAC-IM) providers: PACprovider_relations@carelon.com
Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) providers: DMEprovider_relations@carelon.com

Thank you for your continued partnership.

Carelon Medical Benefits Management transition FAQ

Q: Will there be any changes to the Carelon Post Acute Solutions provider website?

A: The name of our website has been updated to reflect Carelon Medical Benefits Management branding. Additionally, the web address you use today will automatically redirect to a new Carelon Medical Benefits Management site. There will be no changes to the case submission process.

Q: Are any phone number changes planned as part of this transition?

A: No, our inbound phone numbers will not change. The reference to Carelon Post Acute Solutions in recorded scripting will use the Carelon Medical Benefits Management name.

Q: How will third party websites, such as Availity, be impacted?

A: There will be no change to the way you access these websites. Within the sites, any reference to Carelon Post Acute Solutions will be replaced with the new name. This may take some time to fully complete.

Q: Will references to Carelon Post Acute Solutions on health plan websites and other materials be changed?

A: Yes, while you may continue to see the Carelon Post Acute Solutions company name on health plan websites for some time, these references will be updated over time through scheduled content update cycles. If your office includes the Carelon Post Acute Solutions name in any materials or web properties, we encourage you to update them to Carelon Medical Benefits Management during your next update cycle.

Q: Will information about Carelon Post Acute Solutions continue to be found on the corporate website?

A: Yes, post-acute care will be part of the Carelon Medical Benefits Management portfolio of solutions. You can learn more at careloninsights.com.

Q: Will provider resources, such as key documents and the provider finder, be impacted?

A: Our provider resources will continue to be available through our corporate website and our Provider Resources site.

Q: Does this impact provider agreements with Carelon Post Acute Solutions? Will I need to sign a new agreement?

A: No, there is no impact to provider agreements. You do not need to sign a new agreement regardless of whether your current contract is with MyNexus, Inc. or Carelon Post Acute Solutions.

Q: Do I need to complete credentialing again through Carelon Medical Benefits Management?

A: No, providers will not need to re-credential until their normal credentialing cycle.

Q: Will my claims be impacted?

A: No, claims are not impacted. Payer IDs will remain the same.

**Q: Will I need to update my W-9?**

A: Providers may need to update their W-9. If you need an updated W-9 from Carelon Medical Benefits Management, please contact the Carelon Provider Relations department at HHprovider_relations@carelon.com.

Carelon Post Acute Solutions, LLC is an independent company providing services on behalf of the health plan.
Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CRCM-054832-24-CPN53974

AdministrativeCommercialMay 1, 2024

CAA: Maintain your online provider directory information

Maintaining your online provider directory information is essential for member and healthcare partners to connect with you when needed. Access your online provider directory information by visiting anthem.com/provider, then at the top of the webpage, choose Find Care. Review your information and let us know if any of your information we show in our online directory has changed.

Updating your information

Anthem uses the provider data management (PDM) capability available on Availity Essentials to update your provider or facility data. Using the Availity PDM capability meets the quarterly attestation requirement to validate provider demographic data set by the Consolidated Appropriations Act (CAA).

PDM features include:

Updating provider demographic information for all assigned payers in one location.
Attesting to and managing current provider demographic information.
Monitoring submitted demographic updates in real-time with a digital dashboard.
Reviewing the history of previously verified data.

Accessing the PDM application

Log on to Availity.com and select My Providers > Provider Data Management to begin using PDM. Administrators will automatically be granted access to PDM. Additional staff may be given access to PDM by an administrator. To find your administrator, go to My Account Dashboard > My Account > Organization(s) > Administrator Information.

PDM training

PDM training is available:

Learn about and attend one of our training opportunities by visiting here.
View the Availity PDM quick start guide here.
For Roster Automation Standard Template and Roster Automation Rules of Engagement specific training, listen to our recorded webinar here.

Not registered for Availity yet?

If you aren’t registered to use Availity Essentials, signing up is easy and 100% secure. There is no cost for your providers to register or to use any of our digital applications. Start by going to Availity.com and selecting New to Availity? Get Started at the top of the home screen to access the registration page. If you have more than one tax ID number (TIN), please ensure you have registered all TINs associated with your account.

If you have questions regarding registration, reach out to Availity Client Services at 800-AVAILITY.

MULTI-BCBS-CM-056357-24-CPN55995

AdministrativeCommercialMay 1, 2024

Inaccurate laterality and diagnosis combination

Providers must code their claims to the highest level of specificity in accordance with industry standard coding guidelines such as ICD-10-CM coding guidelines and reporting. When an ICD-10-CM diagnosis code has a specified laterality within the code description, the modifier that is appended to a CPT^® or HCPCS code must correspond to the laterality within the ICD-10 description.

For CMS 1500 form claims processed on or after May 30, 2024, Anthem will apply these correct coding ICD-10-CM guidelines and deny claim lines that have a laterality diagnosis submitted with a CPT or HCPCS modifier that does not correspond to the diagnosis.

Example one:

Reported diagnosis:

E11.3593 (Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral)

Billed CPT code:

67228-RT Treatment of extensive or progressive retinopathy (e.g., diabetic retinopathy), photocoagulation.

Determination:

It is not appropriate to report an RT modifier when the laterality of bilateral is identified in the ICD-10 diagnosis. Therefore, the claim line will be denied.

Example two:

Reported diagnosis

S91.011A (Laceration without foreign body, right ankle, initial encounter)

Billed CPT code:

27786-LT (Closed treatment of distal fibular fracture: lateral malleolus; without manipulation)

Determination:

It is not appropriate to report an LT modifier when the laterality of right is identified in the ICD-10 diagnosis. Therefore, the claim lime will be denied.

Additionally, the ICD-10-CM diagnosis code should correspond to the medical record, CPT, HCPCS code(s), and/or modifiers billed.

Anthem will continue to enhance its editing system to automate edits and simplify remittance messaging supported by correct coding guidelines. The enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.

Diagnosis codes with a specified laterality description should be submitted with the appropriate modifier of specificity and procedure code. Ex Code: 00W19

If you have questions about this communication or need assistance, contact your provider relationship management associate.

We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities.

MULTI-BCBS-CM-053055-24

Digital SolutionsCommercialMedicare AdvantageMedicaidMay 1, 2024

Digital Request for Additional Information is now available for all lines of business

Digital Request for Additional Information (RFAI) is the easiest way to submit attachments requested by your payer using Availity Essentials. There is no need to fax or mail paperwork to complete your claim submissions anymore; just use the digital channels provided for your organization.

Availity Essentials notification center

The notification center is located on the top of the Availity Essentials home page. If your payer has requested documentation, there will be a message stating there are requests in your work queue. Simply select the hyperlink to be navigated to the Attachment Dashboard to view the request.

Availity Essentials Attachment Dashboard

The Attachment Dashboard is where all attachment requests are displayed. You can use the hyperlink in the notification center or navigate to Claims & Payments > Attachments New.

To locate a specific RFAI request, the request number will begin with RFAI. If you notice multiple requests in your dashboard, take advantage of the filters. You have the option to search, filter, and sort for multiple values, such as tax ID, NPI, and request type.

Select Upload Attachment to view the type of document requested. Your uploaded requests will be visible in the History tab once accepted. Select the Record History icon on the right side of the request to view the Availity Transaction ID for specific Availity Essentials questions or Health Plan Transaction ID if you need to contact your payer for questions.

Digital RFAI progress dashboard

This dashboard, located in Payer Spaces, allows your organization to understand how many digital requests have been sent, how many finalized claims there are based on your attachment submissions, and the average turnaround time from the initial payer request to the claim finalization. To view your Digital RFAI Progress Dashboard application, select Payer Spaces from the drop-down menu and choose your payer tile.

Get trained

Availity Essentials has training on-demand. This includes a pre-check for administrators and a Learn How to Submit Digital Requests for Additional Information training. Log in to Availity Essentials > Help & Training > Get Trained > Enter RFAI in the keyword search.

Visit the Provider Learning Hub to take Availity on-demand training.

If you have questions, call Availity Client Services at 800-Availity (800-282-4548). Availity Client Services is available Monday to Friday, 8 a.m. to 8 p.m. ET.

With your help, we can continually build towards a future of shared success.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CDCRCM-052709-24-CPN52154

Digital SolutionsCommercialMedicare AdvantageMay 1, 2024

Roster automation update

Roster Automation is our technology solution designed to streamline and automate provider data additions, changes, and terminations that are submitted using a standardized Microsoft Excel template.

On March 29, we introduced a new Roster Automation functionality on the Upload Roster File page of Availity PDM. With this enhancement, you can view:

Date received and status of rosters submitted in the last 12 months.
Errors in submitted rosters that result in the need of manual intervention to process. The types of issues included in the error report will be incorrectly formatted data and required data elements that are missing from the roster.

Understanding the errors made when completing a roster allows you to ensure subsequent submissions do not contain those issues. Error-free rosters reduce the need for manual intervention, which improves data accuracy and processing time.

As you learn how to use the information available in the new error reports, we will continue to correct issues on your behalf.

In the future, you will need to correct any errors submitted in a roster (for example, missing data, incorrectly formatted data). Rows in a roster that contain an error will not be processed and the addition, change, or termination will not be updated in our systems. More information about when you will need to correct errors, and how to do so, will be sent in future communications and covered in future virtual webinars.

Utilize the Roster Submission Guide

Find it online: On Availity.com > Payer Spaces > Select Payer Tile > Resources > Roster Submission Guide using Provider Data Management.

MULTI-BCBS-CRCM-057357-24-CPN57211

Digital SolutionsCommercialApril 23, 2024

Overview of the Preference Center on Availity Essentials

In our previous communications about the Authorizations and Referrals application on Availity Essentials, we mentioned the Preference Center where you can select your preferred method of communication for authorization cases. Below, find details on how to easily access the Preference Center and set your communication preference. The Preference Center, which can be accessed by your Availity administrator or their assistant, will be available on Availity Essentials within Payer Spaces by the end of April 2024.

Access the Preference Center

After logging in to Availity Essentials, your Availity administrator, or their assistant, will select Payer Spaces from the top menu bar, then select the Anthem payer tile. Once in Payer Spaces, select the Preference Center application tile. The Preference Center will prompt them to select your organization.

Set your preferred communication mode for authorization cases

After selecting your organization, select the preference option for Authorization and Referrals to see the preferred communication mode for authorization cases and adjust the preference (Digital Access (Default) or Digital + Mail) based on your business needs.

Once in the preference setting for Authorizations and Referrals, all tax IDs and NPIs for your organization registered with Availity Essentials will be displayed on the screen. The default communication mode for authorization cases will be set to Digital Access for all organizations, including all combinations of tax IDs and NPIs.

You can change the mode of communication to Digital + Mail for any combination of tax ID and NPI. There is no need to manually enter the tax IDs and/or NPIs to set this preference. Instead, use the search bar to focus on the tax IDs and NPIs you want to make changes to. Additionally, you can add more NPIs to your current registration and set the preferred communication mode for the new NPIs under the selected tax IDs.

Manage preferences (Availity administrators)

Availity administrators can learn more about managing preferences related to Authorization Decision letters in the Custom Learning Center, available in Payer Spaces on Availity Essentials.

After logging in to Availity Essentials, select Payer Spaces from the top menu bar, then select the Anthem payer tile. Once in Payer Spaces, select the Custom Learning Center application, then select the Resources section to view or download the Reference Guide on managing receipt of Authorization Decision letters.

Through our shared health vision, we can affect real change.

MULTI-BCBS-CM-056476-24

Digital SolutionsCommercialMedicare AdvantageMedicaidApril 15, 2024

Coming soon — Submit behavioral health authorizations through the Authorization application on Availity

Soon, you will be able to submit all your authorizations in one application on Availity.com.

You may already be submitting your physical health authorizations through the Availity Essentials multi-payer Authorization application — taking advantage of the time savings and speed to care through digital authorization submissions. You will soon be able to submit both your physical health and behavioral health authorizations through one Authorization application on Availity.com.

Using the Availity Authorization application to submit your behavioral health authorizations will not be much different from the process you follow today. You may enjoy more intuitive screens or learn sooner if an authorization is required, but the digital submission process is still the best way to submit your authorization requests and the fastest way to care for our members.

You will continue to use Interactive Care Reviewer (ICR) to submit an appeal or authorization for medical specialty prescriptions.

Accessing the Availity Authorization application is easy. Ask your organization’s Availity administrator to ensure you have the Authorization role assignment. Without the role assignment, you will not be able to access the Authorization application. Then, log on to Availity.com to access the app through the Patient Registration tab by selecting Authorizations and Referrals.

Training is available

Training is available for the Availity Authorization application. Once registered with the authorization role assignment, visit the training site to enroll for an upcoming live webcast or to access an on-demand recording at the Availity Authorization Training Site.

We are focused on reducing administrative burdens, so you can do what you do best — care for our members.

NVBCBS-CDCRCM-049442-23-CPN48753

Digital SolutionsMedicare AdvantageMay 1, 2024

Personalized Match update

Find Care, the doctor finder and transparency tool in the Anthem online directory, provides Anthem members with the ability to search for in-network providers using the secure member website. This tool currently offers multiple sorting options, such as sorting providers based on distance, alphabetical order, and provider name.

We previously introduced you to Personalized Match, an additional Find Care sorting option for Medicare Advantage members, which was based on provider efficiency and quality outcomes, in addition to member search radius. Personalized Match was initially limited to PCP searches and was later expanded to include certain specialists.

Beginning in June 2024 or later, we will further enhance Personalized Match. Provider availability and STARS rating scores will now more directly influence provider rankings. Additionally, provider recommendations will be driven in part by knowledge about member history derived from claims and other available clinical data. Personalized Match will continue to display providers with the highest overall ranking within the member’s search radius at the top of search results. Members may continue to sort based on distance, alphabetical order, and provider name:

A copy of the Personalized Match phase two methodology will be posted in Availity in the coming weeks.
If you have general questions regarding this new sorting option, please submit an inquiry via the web at Availity.
If you would like information about your quality or efficiency scoring used as part of this sorting option or if you would like to request reconsideration of those scores, you may do so by submitting an inquiry to Availity.

Anthem will continue to focus and expand our consumer tools and content to assist members in making more informed and personalized healthcare decisions. We are committed to helping patients more easily access the care they need.

MULTI-BCBS-CR-052330-24-CPN52048

Education & TrainingCommercialApril 25, 2024

Instructions for donor claim billing

Use the information below to help complete required patient information on donor claims. Correct completion of the form is needed to process the claim.

Donor claims

There are two patients involved in an organ donation — the donor and the recipient. The insurance plan for the recipient is responsible for paying the donor claim. The recipient can be the subscriber or a dependent to the subscriber (Note: Plans are instructed to include living donor charges on the recipient claims).

When billing for services rendered to the transplant donor, the care provider enters the recipient’s name, date of birth, sex, and Anthem ID number.

Completing forms

Review the information outlined below for billing instructions needed to process donor claims.

CMS-1450 (UB-04 Uniform Bill):

UB box 8b — recipient’s name*
UB box 10 — recipient’s birthdate
UB box 11 — recipient’s sex
UB box 42 — donor ICD-10-CM codes and revenue codes
UB box 58 — subscriber’s name
UB box 59 — relationship code of 39 or 40
UB box 60 — subscriber ID number
UB box 66 — donor diagnosis codes
UB box 80 — note this is a donor claim submission with donor’s name

CMS-1500 (Health Insurance Claim Form):

HCFA box 1a — subscriber’s ID number
HCFA box 2 — recipient’s name*
HCFA box 3 — recipient’s date of birth and gender
HCFA box 4 — subscriber’s name
HCFA box 6 — relationship to subscriber, other (Complete with 39 or 40.)
HCFA box 19 — note, this is a donor claim submission with donor’s name
HCFA box 21 — donor diagnosis code
HCFA box 53 (electronic claim) — will list the donor’s name:
Example: Claim note ref code: ADD Claim note Text: 39-Jones, Sally

* The recommendation is that the recipient’s name be billed. However, the care provider can bill with the donor’s name. If the claim is billed with the recipient’s name, it has a better chance at adjudication upon initial submission.

We are focused on reducing administrative burdens, so you can do what you do best — care for our members.

MULTI-BCBS-CM-056555-24-CPN54528

Education & TrainingCommercialMedicare AdvantageMay 1, 2024

Rotary to ground educational message

When determining transportation to an alternative hospital and to help avoid medical necessity denials for rotary wing air ambulance transports to another hospital, please remember the criteria below.

The use of air and water ambulance services is considered medically necessary when all the following criteria are met:

The ambulance must have the necessary equipment and supplies to address the needs of the individual; and
The individual’s condition must be such that any form of transportation other than by ambulance would be medically contraindicated; and
The individual’s condition is such that the time needed to transport by land poses a threat to the individual’s survival or seriously endangers the individual’s health*; or the individual’s location is such that accessibility is only feasible by air or water transportation; and
There is a medical condition that is life threatening, or first responders deem to be life threatening, including, but not limited to, the following:

Intracranial bleeding; or
Cardiogenic shock; or
Major burns requiring immediate treatment in a burn center; or
Conditions requiring immediate treatment in a hyperbaric oxygen unit; or
Multiple severe injuries; or
Transplants; or
Limb-threatening trauma; or
High risk pregnancy; or
Acute myocardial infarction; if this would enable the individual to receive a more timely medically necessary intervention (such as percutaneous transluminal coronary angioplasty [PTCA] or fibrinolytic therapy).

* Air transportation may be appropriate if the time between identification of the need for transportation until arrival at the intended destination for ground ambulance would be at least 30 minutes longer than air transport.

For additional details on Clinical UM Guideline CG-ANC-04 Ambulance Services: Air and Ground please visit the Anthem provider site.

Clinical UM guidelines are subject to change. Administrative services only (ASO) accounts may utilize alternate criteria. All terms and conditions of the member’s benefit plan apply.

For more information please contact Provider Services.

MULTI-BCBS-CRCM-052117-24-CPN51828

Education & TrainingMedicaidMarch 31, 2023

Ready, set, renew!

It’s time for some of your patients to renew their Medicaid benefits. As states begin to recommence Medicaid renewals, we want to ensure you have the information needed to help your Medicaid patients renew their healthcare coverage. Some patients have never had to renew their coverage at all, while other patients may have forgotten the process entirely.

We’re here to help.

What steps do my patients need to take?

Ready: Patient gets their documents ready.
Set: Patient ensures their form is all set.
Renew: Patient sends renewal form:
- Via web: dwss.nv.gov
- Via fax: 702-486-1837
- Via mail:
  Division of Welfare and Supportive Services
  Document Imaging Center
  P.O. Box 15400
  Las Vegas, NV 89114

What if I need assistance?

Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials,* go to availity.com and select the appropriate payer space tile from the drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.

For additional support, visit the Contact Us section at the bottom of our provider website for the appropriate contact.

*Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CD-017955-22-CPN16407, NVBCBS-CD-047502-23-CPN047298, NVBCBS-CD-056726-24-CPN56608

Education & TrainingMedicaidMay 1, 2024

SBIRT in action: Improving members’ lives

What is SBIRT?

Screening, Brief Intervention, and Referral to Treatment — commonly referred to as SBIRT — is an evidence-based approach to identifying members who use alcohol and other drugs at dangerous levels. SBIRT’s goal is to reduce and prevent related health consequences, disease, accidents, and injuries. Risky substance use is a health issue that often goes undetected. By incorporating this reliable evidence-based tool — which is demonstrated to be reliable in identifying individuals with risk for a substance use disorder — significant harm can be prevented.

SBIRT can be performed in a variety of settings. Screening does not have to be performed by a physician. SBIRT incorporates screening for all types of substance use with brief, tailored feedback, and advice. Simple feedback on risky behavior can be one of the most critical influences on changing patient behavior.

Why use SBIRT?

SBIRT is an effective tool for identifying risk behavioral and providing appropriate intervention.
By screening for high-risk behavior, healthcare providers can use evidence-based brief interventions focusing on health and consequences, preventing future problems.
Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
SBIRT reduces costly healthcare utilization.
SBIRT is reimbursable through Medicaid.
SBIRT is appropriate for any patient, regardless of age, gender, or health status.

When we say…	We mean…
Screening	Provide a short, structured consultation to identify the right amount of treatment. Use common screening tools (listed below).
Brief intervention	Educate members and increase motivation to reduce risky behavior. Brief education intervention increases motivation to reduce risky behavior. Typically 5 to 10 minutes
Brief treatment	Fulfill goals of: Changing the immediate behavior or thoughts about a risky behavior. Addressing long-standing problems with harmful drinking and drug misuse. Helping members with higher levels of disorder obtain more long-term care. Typically 5 to 12 minutes
Referral to treatment	If a patient meets the diagnostic criteria for substance dependence or other mental illnesses as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, we recommend you refer them to a specialty provider.

Who delivers SBIRT services?

Primary care centers, hospital emergency rooms, trauma centers, and community health settings have the best chance to intervene early with at-risk substance users and prevent more severe consequences. Primary care providers are the primary source of SBIRT services. However, nurse practitioners, physician assistants, and behavioral health providers play an important role as well. SBIRT services are intended to be delivered in primary care medical settings as the first line of substance use harm reduction, identification, and referral to specialized services.

Implementing SBIRT into care management

There are multiple screening tools to use for different populations. Anthem recommends the following screening tools for their brief nature, ease of use, flexibility for multiple types of members, and indication of need for further assessment or intervention:

Screening tool	Age range or population	Overview
Alcohol Use Disorder Identification Test (AUDIT)	All members	Developed by the Word Health Organization. Appropriate for all ages, genders, and cultures
Alcohol, Smoking, and Substance Abuse Involvement Screen Test (ASSIST)	Adults	Simple screener for hazardous use of substances (including alcohol, tobacco, and other drugs).
Drug Abuse Screening Test (DAST-10)	Adults	Screener for drug involvement during last 12 months (does not include alcohol)
Car, Relax, Alone, Forget, Family or Friends, Trouble (CRAFFT)	Adolescents and children	Alcohol and drug screening tool for members under the age of 21. Recommended by the American Academy of Pediatrics.
Screening to Brief Intervention (S2BI)	Adolescents	Assesses frequency of alcohol and substance
NIAAA Alcohol Screening for Youth	Pregnant women	Four-item scale to assess alcohol use in pregnant women; recommended for OB/GYNs
Tolerance, Annoyance, Cut Down, Eye Opener (T-ACE)	Pregnant women	Five-item scale to screen for risky drinking during pregnancy
Tolerance, Worried, Eye Opener, Amnesia, K-Cut Down (TWEAK)	Pregnant women	Five item scale to screen for risky drinking during pregnancy.

Reimbursement

CPT^® code	Code description
99408	SBIRT: Alcohol and substance (other than tobacco) abuse structure screening (for example, AUDIT, DAST) and brief intervention (SBI) services; 15 to 30 minutes
99409	SBIRT: Alcohol and substance (other than tobacco) abuse structure screening (for example, AUDIT, DAST) and brief intervention (SBI) services; over 30 minutes
H0049	SBIRT: Alcohol and/or drug screening

Need help with a referral to a behavioral health specialist?

Referrals can be complex and involve coordination across different types of services. We can help! Contact a provider relationship management representative at 844-396-2330. We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities.

Sources:

Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare, April 1, 2019, samhsa.gov.
Alcohol Screening and Brief Intervention: A Guide for Public Health Practitioners, American Public Health Association, page 8.

NVBCBS-CD-037410-23

Policy UpdatesMedicare AdvantageApril 11, 2024

Carelon Medical Benefits Management, Inc. updates

Effective on June 30, 2024, the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guideline updates for medical necessity review will apply for Anthem:

Genetic Testing:
- Hereditary Cancer Testing
- Carrier Screening in the Prenatal Setting and Preimplantation Genetic Testing
- Genetic Testing for Inherited Conditions

Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff.

NVBCBS-CR-050511-24-CPN49780

Policy UpdatesMedicaidMay 1, 2024

Covered services

Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) covers healthcare services based on the Medicaid fee schedule. Services covered will be administered up to the limits/guidance as outlined in the appropriate Nevada Medicaid Service Manuals. Under the rules of the Nevada Medicaid Services Manual, some services are limited by number of provider visits or by number of supply and equipment items.

Some procedure codes on the Medicaid fee schedule do not have rates loaded and will show with a $0.00 rate. Procedure codes with a $0.00 rate are reimbursed at 62% of usual and customary charges unless noted otherwise in Nevada Medicaid policy.

If a procedure code is not listed on the fee schedule, it is considered a non-covered code. Non-covered codes are not reimbursable and if billed, will deny.

We encourage providers to stay informed on Anthem policies, processes, and news by utilizing our website at https://providers.anthem.com/nv.

NVBCBS-CD-055922-24, NVBCBS-CD-019357-23

Prior AuthorizationMedicaidApril 18, 2024

Prior Authorization update - Idacio

Prior authorization updates for medications billed under the medical benefit

Effective on June 1, 2024, the following medication codes billed on medical claims from current or new Clinical Criteria documents will require prior authorization.

Inclusion of a national drug code on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria	HCPCS or CPT^® code(s)	Drug name
CC-0062	J3490	Idacio (adalimumab-aacf)

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local provider relationship management representative or call Provider Services at 800-454-3730.

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

NVBCBS-CD-040833-23-CPN40471

Reimbursement PoliciesCommercialApril 3, 2024

Reimbursement policy update: Laboratory and Venipuncture Services — Professional and Facility

In the March 2024 issue of Provider News, we announced that language was inadvertently removed from the Modifier 26 comment in Section II. The policy has been updated to include the following statement:

When a professional provider has reported modifier 26 to procedure codes designated with NPFSRVF PC/TC indicators 3 or 9, the procedure will not be eligible for reimbursement.

Upon further review, no claims were impacted by this omission. If you believe a claim reimbursement decision should be reviewed, please follow the normal claims dispute process outlined in the provider manual.

MULTI-BCBS-CM-054341-24

Federal Employee Program (FEP)CommercialMay 1, 2024

HEDIS tips: Adult Immunization Status (AIS-E)

HEDIS^® is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

What vaccines are included in the HEDIS Adult Immunization Status (AIS-E) measure?

Influenza: The percentage of members 19 years of age and older who are up to date on recommended routine vaccines for influenza.

Td/Tdap: The percentage of members 19 years of age and older who are up to date on recommended routine vaccines for tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap).

Zoster: The percentage of members 50 years of age and older who are up to date on recommended routine vaccines for zoster.

Pneumococcal: The percentage of members 66 years of age and older who are up to date on recommended routine vaccines for pneumococcal.

Using correct codes can help your practice improve HEDIS AIS-E results.

Using the correct code to capture the vaccine given, or identifying anaphylaxis code to reflect the contraindications, can help your practice with performance rates.

Adult immunization

Immunization description	CPT^® codes	HCPCS	CVX
Influenza immunization	90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90672, 90673, 90674, 90682, 90685, 90686, 90687, 90688, 90689, 90694, 90756	G0008	88, 135, 140, 141,144, 150, 150, 153, 155, 158, 166, 168, 168, 171, 185, 186, 197, 205
Td/Tdap	90714, 90715		09, 113, 115, 138, 139
Zoster immunization	90736, 90750		121, 187
Pneumococcal immunization	90670, 90671, 90677, 90732	G0009	33, 109, 133, 152, 215, 216

* Influenza live virus

Sources: 1. NCQA Health Plan Description AND ECDS: Adult Immunization Status, pages 643 to 650.
2. HEDIS MY 2024 Volume 2 Value Set Directory 2023-08-01: tabs Measures to Value Sets and Value Sets to Codes.

Exclusions:

Members who use hospice services; or
Members who elect to use a hospice benefit any time during the measurement period; or
Members who die any time during the measurement period.
Members with a history of at least one of the following contraindications any time during the measurement period.

Exclusions codes for anaphylaxis

Immunization description	SNOMED CT edition USA codes	Description
Influenza immunization	47136000124100	Anaphylaxis due to the influenza vaccine any time before or during the measurement period
Td/Tdap	428281000124107 428291000124105 192710009 192711008 192712001	Members with a history of at least one of the following contraindications any time before or during the measurement period: Anaphylaxis due to diphtheria, tetanus, or pertussis vaccine (caused by diphtheria and tetanus) Anaphylaxis due to diphtheria, tetanus, or pertussis vaccine (caused by tetanus, diphtheria and acellular pertussis) Encephalitis due to diphtheria, tetanus, or pertussis vaccine (post tetanus vaccination) Encephalitis due to diphtheria, tetanus, or pertussis vaccine (post diphtheria vaccination) Encephalitis due to diphtheria, tetanus, or pertussis vaccine (post pertussis vaccination)
Zoster immunization	471381000124105	Members with anaphylaxis due to the herpes zoster vaccine any time before or during the measurement period
Pneumococcal immunization	471141000124102	Members with anaphylaxis due to the pneumococcal vaccine any time before or during the measurement period

Helpful tips

Immunization information obtained from the medical record:

A note indicating the name of the specific antigen and the date of the immunization.
A certificate of immunization prepared by an authorized healthcare provider or agency, including the specific dates and types of immunization administered.
Document in the medical record of refusal or anaphylaxis reaction to the serum/vaccination.

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

MULTI-BCBS-CM-054689-24-CPN54510

PharmacyCommercialApril 24, 2024

Specialty pharmacy updates — May 2024

Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by the Medical Specialty Drug Review team of Anthem. Review of specialty pharmacy drugs for oncology use is managed by Carelon Medical Benefits Management, Inc.

Important to note: Currently, your patients may be receiving these medications without prior authorization. As of the effective date below, you may be required to request prior authorization review for your patients’ continued use of these medications.

Inclusion of a national drug code (NDC) code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

Prior authorization updates

Effective for dates of service on and after August 1, 2024, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our prior authorization review process.

Access our Clinical Criteria here view the complete information for these prior authorization updates.

Clinical Criteria	Drug	HCPCS or CPT^® code(s)
CC-0259	Amtagvi (lifleucel)	J3490, J3590
CC-0258	iDoseTR (travoprost Implant)	J3490, J3590
CC-0260	Nexobrid (anacaulase-bcdb)	J7353

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

Quantity limit updates

Effective for dates of service on and after August 1, 2024, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our quantity limit review process.

Access our Clinical Criteria here view the complete information for these quantity limit updates.

Clinical Criteria	Drug	HCPCS or CPT code(s)
CC-0064	Arcalyst (rilonacept)	J2793
CC-0139	Evenity (romosozumab-aqqg)	J3111
CC-0258	iDoseTR (travoprost Implant)	J3490, J3590
CC-0064	Interleukin-1 Inhibitors (Ilaris)	J0638
CC-0057	Krystexxa (pegloticase)	J2507
CC-0260	Nexobrid (anacaulase-bcdb)	J7353
CC-0068	Genotropin, Humatrope, Norditropin, Nutropin, Omnitrope, Saizen, Saizenprep, Serostim, Zomacton, Zorbtive (somatropin drugs)	J2941
CC-0047	Trogarzo (ibalizumab-uiyk)	J1746
CC-0067	Tyvaso (treprostinil)	J7686
CC-0067	Ventavis (Iloprost)	Q4074

Site of care updates

Effective for dates of service on and after August 1, 2024, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our site of care review process.

Access our Clinical Criteria here view the complete information for these site of care updates.

Clinical Criteria	Drug	HCPCS or CPT code(s)
CC-0252	Adzynma (ADAMTS13, recombinant-krhn)	C9167
CC-0001	Aranesp (darbepoetin alfa)	J0881
CC-0034	Berinert (c1 esterase inhibitor (human))	J0597
CC-0042	Bimzelx (bimekizumab-bkzx)	C9399, J3590
CC-0042	Cosentyx (secukinumab)	C9399, J3490, J3590
CC-0061	Eligard, Lupron Depot (leuprolide acetate)	J9217
CC-0001	Epogen, Procrit (epoetin alfa)	J0885
CC-0034	Kalbitor (ecallantide)	J1290
CC-0228	Leqembi (lecanemab)	J0174
CC-0061	Leuprolide Acetate Depot (Cipla) (leuprolide acetate)	J1954
CC-0061	Lupron Depot (leuprolide acetate)	J1950
CC-0111	Nplate (romiplostim)	J2796
CC-0050	Omvoh (mirikizumab-mrkz)	C9168
CC-0018	Pombiliti (cipaglucosidase alfa-atga)	J1203
CC-0001	Retacrit (epoetin alfa-epbx)	Q5106
CC-0235	Revcovi (elapegademase-lvlr)	C9399, J3590
CC-0256	Rivfloza (nedosiran)	J3490
CC-0034	Ruconest (recombinant c1esterase inhibitor)	J0596
CC-0203	Ryplazim (plasminogen, human-tvmh)	J2998
CC-0058	Sandostatin (octreotide)	J2354
CC-0058	Sandostatin LAR Depot (octreotide)	J2353
CC-0236	Signifor LAR (pasireotide)	J2502
CC-0066	Tofidence (tocilizumab-bavi)	Q5133
CC-0020	Tyruko (natalizumab-sztn)	Q5134
CC-0250	Veopoz (pozelimab-bbfg)	J9376
CC-0257	Wainua (eplontersen)	C9399, J3490
CC-0254	Zilbrysq (zilucoplan)	J3490
CC-0062	Zymfentra (infliximab-dyyb)	J3590

MULTI-BCBS-CM-055424-24-CPN54800

PharmacyMedicaidApril 16, 2024

Prior authorization updates for medications billed under the medical benefit

Effective June 1, 2024, the following medication codes will require prior authorization.

Please note, inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria	HCPCS or CPT^® code(s)	Drug name
CC-0244	J9286	Columvi (glofitamab-gxbm)
CC-0245	C9162	Izervay (avacincaptad pegol)
CC-0246	J9333	Rystiggo (rozanolixizumab-noli)
CC-0207	J9334	Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-gvfc)
CC-0072	C9161	Eylea HD (aflibercept high dose)

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local provider relations representative or call Provider Services at 844-396-2330.

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

NVBCBS-CD-050810-24-CPN50561

PharmacyMedicare AdvantageApril 8, 2024

Anthem expands specialty pharmacy precertification list

Effective for dates of service on and after August 1, 2024, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and CMS guidelines — including definitions and specific contract provisions/exclusions — take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

HCPCS or CPT^® codes	Medicare Part B drugs
J9286	Columvi (glofitamab-gxbm)
C9162, J3490, J3590, J9999	Izervay (avacincaptad pegol)
J9333	Rystiggo (rozanolixizumab-noli)
J9334	Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-gvfc)

We look forward to working together to achieve improved outcomes.

MULTI-BCBS-CR-053057-24-CPN52693

PharmacyCommercialApril 9, 2024

Acquisition of Paragon Healthcare

Elevance Health, the parent company of our pharmacy benefit management partner, CarelonRx, Inc., has completed its acquisition of Paragon Healthcare, Inc., a company specializing in life-saving and life-giving infusible and injectable therapies.

Paragon Healthcare provides infusion services to members through its omnichannel model of ambulatory infusion centers, home infusion pharmacies, and other specialty pharmacy services. The company, headquartered in Plano, Texas, currently serves more than 35,000 members at over 40 ambulatory infusion centers across eight states, as well as in members’ homes.

The acquisition of Paragon Healthcare will deepen our capabilities around providing affordable, convenient access to specialty medications for those living with chronic and complex illnesses. Paragon Healthcare will operate as part of CarelonRx.

CarelonRx plans to expand Paragon Healthcare’s geographical footprint and operations while bolstering its therapeutic coverage to ensure members receive convenient, timely access to medications.

We share a health vision with our care providers that means real change for consumers.

CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the health plan.

MULTI-BCBS-CM-054706-24-CPN53991

PharmacyCommercialMarch 1, 2024

Pharmacy information available on our provider website

Visit the Drug Lists page on our website at anthem.com/ms/pharmacyinformation/home.html for more information about:

Copayment/coinsurance requirements and their applicable drug classes.
Drug lists and changes.
Prior authorization criteria.
Procedures for generic substitution.
Therapeutic interchange.
Step therapy or other management methods subject to prescribing decisions.
Any other requirements, restrictions, or limitations that apply to using certain drugs.

The commercial and exchange drug lists are posted to the website quarterly on the first day of the month in January, April, July, and October.

To locate the exchange, select Formulary and Pharmacy Information and scroll down to Select Drug Lists. This drug list is also reviewed and updated regularly as needed.

Federal Employee Program pharmacy updates and other pharmacy related information may be accessed at fepblue.org > Pharmacy Benefits.

Please call provider services to request a copy of the pharmaceutical information available online if you do not have internet access.

Through our efforts, we are committed to reducing administrative burden because we value you, our care provider partner.

MULTI-BCBS-CM-050732-24-CPN50598, MULTI-BCBS-CM-053029-24-CPN53029

PharmacyMedicaidMarch 27, 2024

Prior authorization and specialty pharmacy medical step therapy requirements

Prior authorization updates

Effective for dates of service on and after May 1, 2024, the following medication codes billed on medical claims from current or new Clinical Criteria documents will require prior authorization.

Please note, inclusion of a national drug code on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria	HCPCS codes	Drug name
CC-0248	C9165, J3490, J3590, J9999	Elrexfio (elranatamab-bcmm)
CC-0068	C9399, J3590	Ngenla (somatrogon-ghla)
CC-0018	J3490, J3590	Pombiliti (cipaglucosidase alfa-atga)
CC-0249	C9163, J3490, J3590, J9999	Talvey (talquetamab-tgvs)
CC-0020	J3490, J3590	Tyruko (natalizumab-sztn)
CC-0250	C9399, J3590	Veopoz (pozelimab-bbfg)
CC-0251	C9164, J3490	Ycanth (cantharidin)

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

Step therapy updates

Effective for dates of service on and after May 1, 2024, the following specialty pharmacy code from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon prior authorization initiation or renewal in addition to the current medical necessity review of the drug noted below.

Clinical Criteria	Status	Drug(s)	HCPCS codes
CC-0020	Non-Preferred	Tyruko (natalizumab-sztn)	J3490, J3590

What if I need assistance?

NVBCBS-CD-050737-24-CPN50563

PharmacyMedicare AdvantageApril 5, 2024

CarelonRx, Inc. Mail changed to CarelonRx Pharmacy on January 1, 2024

CarelonRx mail service pharmacy changed to CarelonRx Pharmacy on January 1, 2024.

This pharmacy change does not affect the way CarelonRx works with care providers. There are no changes to the prior authorization process, how claims are processed, or level of support.

This change does not impact your patients’ benefits, coverage, or how their medications are filled.

When e-prescribing orders to the mail service pharmacy:

Prescribers will need to choose CarelonRx Pharmacy, not CarelonRx Mail, if searching by name. If searching by NPI (National Provider Identifier), the NPI is changing to 1568179489.

We are taking steps to ensure a smooth transition to our new home delivery pharmacy for your patients:

Patients will receive a letter to alert them of their new pharmacy.
If a patient has refills left, we will move them to CarelonRx Pharmacy, and we’ll also transfer auto refills.
If a patient does not have any refills left of their medication(s), CarelonRx Pharmacy will contact you to obtain a new prescription.
If a patient is taking a controlled substance, CarelonRx Pharmacy will contact you to obtain a new prescription.
All prior authorizations will be transitioned to CarelonRx Pharmacy.

CarelonRx Pharmacy delivers an enhanced, digital-first solution to your patients to improve adherence and lower costs, while removing barriers associated with traditional retail and mail order pharmacy models. Some highlights include:

24/7 text or chat (digitally) directly with our pharmacists at any time.
Enhanced end-to-end order status tracking from prescription order to delivery.
Free delivery of their 90-day supply, directly to a patient’s door.

CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the health plan.

MULTI-BCBS-CR-045499-23-CPN45113

Quality ManagementMedicaidMay 1, 2024

HEDIS diabetes documentation

HEDIS^® 2023 documentation for Blood Pressure Control for Patients With Diabetes (BPD)

Measure description

The percentage of members 18 to 75 years of age with diabetes (types 1 and 2) whose blood pressure (BP) was adequately controlled (< 140/90 mm Hg) during the measurement year

What we are looking for in provider records:

Last BP documented in 2023 regardless of reading
Evidence of hospice or palliative services in 2023
Evidence patient expired in 2023
Documentation of polycystic ovarian syndrome, gestational diabetes, or steroid induced diabetes

Helpful hints:

Take a second BP at the end of the office visit if initial BP was > 140/90 and document new BP.
Consider taking BP at every visit.
Remind medical staff not to round results. Results must be precise (such as, 139/89).
Compliance is greater than 139/89.
Counsel on healthy habits for managing high blood pressure.
Encourage antihypertensive and other medication adherence.
Member reported BPs during a telehealth visit are acceptable and should be documented in the members health record.
Review diabetic services needed at each office visit.
For members who have not been diagnosed with diabetes but take a diabetes medication for off-label use, document why they are taking medication (for example, weight loss, congestive heart failure, chronic kidney disease, etc.).

HEDIS 2023 documentation for Hemoglobin A1c Control for Patients With Diabetes (HBD)

Measure description

The percentage of members 18 to 75 years of age with diabetes (types 1 and 2) whose hemoglobin A1c (HbA1c) was at the following levels during the measurement year:

HbA1c control (< 8.0%)
HbA1c poor control (> 9.0%)

What we are looking for in provider records:

Last HbA1c documented in 2023 regardless of result
Evidence of hospice or palliative services in 2023
Evidence patient expired in 2023
Documentation of polycystic ovarian syndrome, gestational diabetes, or steroid induced diabetes

Helpful hints:

Counsel on healthy habits for managing diabetes.
If appropriate, set an HbA1c goal of less than 7%.
Encourage timely HbA1c testing.
Encourage medication adherence.
Encourage continuous glucose monitoring.
In progress notes when documenting HbA1c value include date the test was performed.
Review diabetic services needed at each office visit.
For members who have not been diagnosed with diabetes but take a diabetes medication for off-label use, document why they are taking medication (for example, weight loss, congestive heart failure, chronic kidney disease, etc.).

HEDIS 2023 documentation for Eye Exam for Patients With Diabetes (EED)

Measure description

The percentage of members 18 to 75 years of age with diabetes (types 1 and 2) who had a retinal eye exam

What we are looking for in provider records:

Evidence of a retinal eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year or year prior with results
Bilateral eye enucleation any time during the member’s history
Evidence of hospice or palliative services in 2023
Evidence patient expired in 2023
Documentation of polycystic ovarian syndrome, gestational diabetes, or steroid induced diabetes

Helpful hints:

Refer patients to an optometrist or ophthalmologist for a dilated or retinal eye exam annually.
Fundus/retinal photography is considered imaging and is eligible for use, must be dated and interpreted by an eye care professional.
Counsel on healthy habits for managing diabetes.
In progress notes when documenting a retinal eye exam include the name of eye care provider or optometrist/ophthalmologist credentials, date performed, and result.
Encourage medication adherence.
Review diabetic services needed at each office visit.
For members who have not been diagnosed with diabetes but take a diabetes medication for off-label use, document why they are taking medication (for example, weight loss, congestive heart failure, chronic kidney disease, etc.).

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

NVBCBS-CD-041660-23-CPN41092

May 2024 Provider Newsletter

Contents

To view this publication online:

Carelon Medical Benefits Management transition FAQ

Q: Will there be any changes to the Carelon Post Acute Solutions provider website?

Q: Are any phone number changes planned as part of this transition?

Q: How will third party websites, such as Availity, be impacted?

Q: Will references to Carelon Post Acute Solutions on health plan websites and other materials be changed?

Q: Will information about Carelon Post Acute Solutions continue to be found on the corporate website?

Q: Will provider resources, such as key documents and the provider finder, be impacted?

Q: Does this impact provider agreements with Carelon Post Acute Solutions? Will I need to sign a new agreement?

Q: Do I need to complete credentialing again through Carelon Medical Benefits Management?

Q: Will my claims be impacted?

Q: Will I need to update my W-9?

To view this article online:

Updating your information

Accessing the PDM application

PDM training

Not registered for Availity yet?

To view this article online:

Example one:

Example two:

To view this article online:

Availity Essentials notification center

Availity Essentials Attachment Dashboard

Digital RFAI progress dashboard

Get trained

To view this article online:

Utilize the Roster Submission Guide

To view this article online:

Access the Preference Center

Set your preferred communication mode for authorization cases

Manage preferences (Availity administrators)

To view this article online:

Training is available

To view this article online:

To view this article online:

Donor claims

Completing forms

CMS-1450 (UB-04 Uniform Bill):

CMS-1500 (Health Insurance Claim Form):

To view this article online:

To view this article online:

To view this article online:

What is SBIRT?

Why use SBIRT?

Who delivers SBIRT services?

Implementing SBIRT into care management

Reimbursement

Need help with a referral to a behavioral health specialist?

Sources:

To view this article online:

To view this article online:

To view this article online:

What if I need assistance?

To view this article online:

To view this article online:

What vaccines are included in the HEDIS Adult Immunization Status (AIS-E) measure?

Using correct codes can help your practice improve HEDIS AIS-E results.

Adult immunization

Exclusions:

Exclusions codes for anaphylaxis

Helpful tips

To view this article online:

Prior authorization updates

Quantity limit updates

Site of care updates

To view this article online:

What if I need assistance?

To view this article online:

To view this article online:

To view this article online:

To view this article online:

Prior authorization updates

Step therapy updates

What if I need assistance?

To view this article online:

When e-prescribing orders to the mail service pharmacy:

To view this article online:

HEDIS® 2023 documentation for Blood Pressure Control for Patients With Diabetes (BPD)

**Q: Will I need to update my W-9?**

HEDIS^® 2023 documentation for Blood Pressure Control for Patients With Diabetes (BPD)