CommercialMedicare AdvantageMedicaidOctober 1, 2024

October 2024 Provider Newsletter

Featured Articles

Digital SolutionsMedicare AdvantageOctober 1, 2024

Introducing the Care Provider Recognition Program from Anthem

Digital SolutionsCommercialMedicare AdvantageMedicaidSeptember 12, 2024

Roster Automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Prior AuthorizationMedicare AdvantageSeptember 6, 2024

Changes to special supplemental benefits for the chronically ill eligibility requirements

Products & ProgramsCommercialOctober 1, 2024

Name change — Pathway PPO to Blue Priority PPO


Administrative

AdministrativeCommercialOctober 1, 2024

Provider manual update available effective January 1, 2025

AdministrativeCommercialOctober 1, 2024

National Accounts 2025 precertification list

AdministrativeCommercialOctober 1, 2024

Drug fee schedule update

Digital SolutionsMedicare AdvantageMedicaidSeptember 18, 2024

Expansion of digital-only authorization case status notifications

Digital SolutionsMedicare AdvantageMedicaidSeptember 20, 2024

Coming soon — digital-only authorization case status notifications

Digital SolutionsCommercialMedicare AdvantageMedicaidSeptember 4, 2024

Digital Provider Enrollment now available for additional provider types in Availity Essentials

Education & Training

Education & TrainingMedicare AdvantageSeptember 16, 2024

Seamless advance care: MyDirectives digital tool for D-SNP members

Policy Updates

Policy UpdatesMedicare AdvantageSeptember 3, 2024

Clinical Criteria updates

Effective October 4, 2024

Policy UpdatesMedicaidSeptember 20, 2024

Clinical Criteria updates

Effective October 23, 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageSeptember 10, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective October 10, 2024

Prior AuthorizationMedicaidSeptember 19, 2024

Prior authorization requirement changes

Effective November 1, 2024
Code: C9790

Prior AuthorizationMedicaidSeptember 19, 2024

Prior authorization requirement changes

Effective November 1, 2024
Codes: 31242, 31243, 33276, 33277, 61889, 61891, 64596, 64597, J1412, J1413, L5615, and L5926

Prior AuthorizationMedicare AdvantageSeptember 23, 2024

Prior authorization requirement changes

Effective January 1, 2025

Products & Programs

PharmacyCommercialSeptember 16, 2024

Material adverse change

Specialty pharmacy updates — October 2024

PharmacyCommercialOctober 1, 2024

Pharmacy information available on our provider website

Quality Management

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 1, 2024

HEDIS medical record submission made easier with our Remote EMR Access service

NVBCBS-CDCRCM-067879-24

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