CommercialMedicare AdvantageMedicaidAugust 1, 2023

August 2023 Provider Newsletter

Featured Articles

Education & TrainingCommercialMedicare AdvantageAugust 1, 2023

Looking to earn CME credits? Check out the CME Engagement Hub!


Administrative

AdministrativeMedicaidAugust 1, 2023

Clinical Laboratory Improvement Amendments

AdministrativeCommercialMedicare AdvantageAugust 1, 2023

Clinical Laboratory Improvement Amendments

AdministrativeMedicare AdvantageJuly 18, 2023

Urinary tract infection tool kits are on the way

AdministrativeCommercialAugust 1, 2023

Federal Consolidated Appropriations Act (CAA) Gag Clause

AdministrativeCommercialAugust 1, 2023

CAA: Review your online provider directory information regularly

AdministrativeCommercialAugust 1, 2023

Provider Manual updated effective November 1, 2023

Policy Updates

Policy UpdatesMedicaidJuly 17, 2023

Clinical Criteria Updates - March 2023
*Material adverse change (MAC)

Policy UpdatesMedicare AdvantageJuly 3, 2023

Itemized Bill Review (IBR) Program

Policy UpdatesMedicare AdvantageJune 29, 2023

Clinical Criteria Updates - March 2023
*Material adverse change (MAC)

Prior AuthorizationMedicare AdvantageJuly 25, 2023

Prior authorization requirement changes effective November 1, 2023

Prior AuthorizationMedicaidAugust 1, 2023

Fylnetra, Stimufend, and Rolvedon Medical Step Therapy Notice

Reimbursement PoliciesCommercialAugust 1, 2023

Reimbursement policy update: Virtual Visits — Professional and Facility

Reimbursement PoliciesMedicaidAugust 1, 2023

Technology Assisted Surgical Procedures

Reimbursement PoliciesMedicare AdvantageAugust 1, 2023

Technology Assisted Surgical Procedures

Reimbursement PoliciesCommercialAugust 1, 2023

New reimbursement policy: Split Care Surgical Modifiers — Professional

Products & Programs

PharmacyCommercialAugust 1, 2023

Specialty pharmacy updates for August 2023

PharmacyCommercialAugust 1, 2023

Specialty pharmacy updates - August 2023

PharmacyCommercialAugust 1, 2023

Clinical Criteria updates for specialty pharmacy

PharmacyCommercialAugust 1, 2023

Pharmacy information available on our provider website

PharmacyMedicare AdvantageAugust 1, 2023

Medication adherence: Back to the basics

PharmacyMedicare AdvantageAugust 1, 2023

Why statin therapy is important in your patients with diabetes

Quality Management

Quality ManagementMedicare AdvantageMedicaidAugust 1, 2023

Healthy blood pressure recheck initiative

Quality ManagementCommercialMedicaidAugust 1, 2023

Congenital syphilis is a sentinel health event

Quality ManagementCommercialMedicare AdvantageMedicaidJuly 14, 2023

Pharmacotherapy Management of COPD Exacerbation (PCE) HEDIS® Measure

NYBCBS-CDCRCM-030306-23

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. 
Availity, LLC is an independent company providing administrative support services on behalf of the health plan