November 1, 2023
November 2023 Provider Newsletter
Featured Articles
CommercialMedicare AdvantageMedicaidNovember 1, 2023
Reminder: Start using PDM capability now available on Availity Essentials — prior to retirement of previous intake channels
CommercialNovember 1, 2023
Digital RFAI process improvements
CommercialMedicaidNovember 1, 2023
Practitioners’ rights during credentialing process
CommercialNovember 1, 2023
Medical record documentation and signature requirements
Administrative
Medicare AdvantageNovember 1, 2023
Updates to correct coding editingMedicare AdvantageNovember 1, 2023
Usage of liability modifiersMedicare AdvantageNovember 1, 2023
2024 Medicare Advantage service area and benefit updatesCommercialNovember 1, 2023
CAA: Maintain your online provider directory informationCommercialMedicare AdvantageMedicaidNovember 1, 2023
Changes to our data management system help streamline your demographic update processCommercialNovember 1, 2023
Filing digital claims disputes: Transparent and trackablePolicy Updates
MedicaidOctober 23, 2023
Clinical Criteria updates - June 2023Medicare AdvantageNovember 1, 2023
Carelon Medical Benefits Management, Inc. updates — November 2023Medicare AdvantageOctober 19, 2023
Expansion of Carelon Medical Benefits Management, Inc. programsMedicaidOctober 24, 2023
Prior authorization update - Lamzede, Lunsumio, Rebyota, etc.Medicare AdvantageOctober 16, 2023
RETRACTION: Prior authorization requirement changes effective February 1, 2024Codes 32274 and 32275
Medicare AdvantageOctober 3, 2023
Prior authorization requirement changes effective February 1, 2024 - code J1411CommercialSeptember 28, 2023
Expansion of Carelon Medical Benefits Management, Inc. programs, effective April 1, 2024CommercialNovember 1, 2023
Reimbursement policy update: Pharmaceutical Waste – Professional and FacilityProducts & Programs
CommercialNovember 1, 2023
Federal Employee Program specialty pharmacy prior authorization reviewCommercialNovember 1, 2023
FEP® Specialty Pharmacy prior authorization listCommercialNovember 1, 2023
Specialty pharmacy updatesCommercialNovember 1, 2023
Pharmacy information available on our provider websiteQuality Management
MedicaidNovember 1, 2023
Healthy blood pressure recheck initiativeMedicare AdvantageNovember 1, 2023
Controlling high blood pressure and HEDISMedicaidNovember 1, 2023
Controlling high blood pressure and HEDISCommercialMedicare AdvantageOctober 25, 2023
HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS)CommercialMedicare AdvantageSeptember 27, 2023
Be Antibiotics Aware: Protect your patientsCommercialMedicare AdvantageNovember 1, 2023
HEDIS measurement year 2023 documentation for Transitions of Care (TRC)CommercialMedicare AdvantageOctober 15, 2023
HEDIS medical record submission made easier with our Remote EMR Access ServiceMedicare AdvantageNovember 1, 2023
Statin therapy end of year best practicesNVBCBS-CDCRCM-041571-23
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