CommercialMedicare AdvantageMedicaidMarch 1, 2024

March 2024 Provider Newsletter

Administrative

AdministrativeMedicare AdvantageMarch 1, 2024

CAA: Maintain your online provider directory information

AdministrativeCommercialMedicare AdvantageMedicaidMarch 1, 2024

Using the correct Anthem EDI payer ID

Digital SolutionsMedicare AdvantageFebruary 29, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Digital SolutionsCommercialMarch 1, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsCommercialFebruary 21, 2024

Beginning February 2024, you can submit Physical Health prior authorizations through the Authorization application on Availity.com

Education & Training

Education & TrainingMedicaidMarch 1, 2024

Resources to support your diverse patient panel

Education & TrainingCommercialMedicaidMarch 1, 2024

Congenital syphilis intervention opportunities for neonatal and pediatric providers

Policy Updates

Policy UpdatesMedicare AdvantageFebruary 16, 2024

MCG Care Guidelines 27th edition update

Medical Policy & Clinical GuidelinesMedicare AdvantageFebruary 20, 2024

Clinical Criteria updates — December 2023

Medical Policy & Clinical GuidelinesMedicaidFebruary 21, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 1, 2024

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationCommercialMarch 1, 2024

Precertification list change notification

Prior AuthorizationMedicaidFebruary 20, 2024

Prior authorization requirement changes effective May 1, 2024

Prior AuthorizationMedicare AdvantageFebruary 1, 2024

Prior authorization requirement changes effective May 1, 2024

Codes G0481 - G0483

Prior AuthorizationMedicare AdvantageJanuary 24, 2024

Prior authorization requirement changes effective May 1, 2024

Code C1825

Reimbursement PoliciesCommercialMarch 1, 2024

Reimbursement policy update: Ambulance Transportation – Professional

Products & Programs

PharmacyMedicare AdvantageMarch 1, 2024

Overview of Medicare risk adjustment in-office prospective programs

PharmacyMedicare AdvantageFebruary 16, 2024

Anthem expands specialty pharmacy precertification list

PharmacyCommercialFebruary 20, 2024

Prior authorization updates for therapeutic duplication of specialty drugs

PharmacyCommercialMarch 1, 2024

Pharmacy information available on our provider website

PharmacyMedicaidMarch 1, 2024

Quarterly pharmacy formulary change notice

PharmacyCommercialMarch 1, 2024

Important information about your Anthem patients’ Botox prescriptions

PharmacyMedicaidFebruary 21, 2024

Prior authorization updates for medications billed under the medical benefit

PharmacyCommercialFebruary 22, 2024

Specialty pharmacy updates — March 2024

PharmacyMedicare AdvantageJanuary 31, 2024

Notification of specialty pharmacy medical step therapy updates

PharmacyCommercialMarch 1, 2024

Clinical Criteria updates for specialty pharmacy

Quality Management

Quality ManagementMedicare AdvantageFebruary 7, 2024

HEDIS® 2024 documentation for Care of Older Adults (COA)

Quality ManagementCommercialMedicare AdvantageMedicaidFebruary 6, 2024

HEDIS 2024 documentation for Controlling High Blood Pressure (CBP) and Statin Therapy for Patients with Cardiovascular Disease (SPC)

Quality ManagementCommercialMedicaidMarch 1, 2024

Encourage Cervical Cancer Screening (CCS)

Quality ManagementCommercialMedicaidMarch 1, 2024

Cervical Cancer Screening (CCS) and Prenatal and Postpartum Care (PPC) for HEDIS

Quality ManagementCommercialMedicare AdvantageMedicaidJanuary 29, 2024

HEDIS Breast Cancer Screening (BCS) update

Quality ManagementCommercialMarch 1, 2024

Boost annual preventive care visits: Tips and resources: An ounce of prevention is worth a pound of cure

NYBCBS-CDCRCM-051145-24

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