CommercialMedicare AdvantageMedicaidMay 1, 2024

May 2024 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageMedicaidMay 1, 2024

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

PharmacyMedicare AdvantageMedicaidApril 5, 2024

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

Administrative

AdministrativeCommercialMay 1, 2024

Inaccurate laterality and diagnosis combination

AdministrativeMedicare AdvantageMedicaidMay 1, 2024

Inaccurate laterality and diagnosis combination

AdministrativeCommercialApril 11, 2024

Utilizing participating commercial laboratories

AdministrativeCommercialMedicare AdvantageMay 1, 2024

Carelon Post Acute Solutions, LLC will begin operating as Carelon Medical Benefits Management, Inc.

AdministrativeCommercialMay 1, 2024

CAA: Maintain your online provider directory information

Digital SolutionsMedicare AdvantageMedicaidApril 26, 2024

Introducing new functionality for non-medical providers

Digital SolutionsCommercialApril 23, 2024

Overview of the Preference Center on Availity Essentials

Digital SolutionsCommercialMedicare AdvantageMedicaidMay 1, 2024

Roster automation update

Digital SolutionsCommercialMedicare AdvantageMedicaidApril 15, 2024

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

Digital SolutionsMedicare AdvantageMay 1, 2024

Personalized Match update

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaidMay 1, 2024

Rotary to ground educational message

Education & TrainingCommercialApril 25, 2024

Instructions for donor claim billing

Education & TrainingMedicaidApril 22, 2024

Human papillomavirus documentation, coding, and tips for success

Education & TrainingMedicaidMarch 31, 2023

Ready, set, renew!

Education & TrainingMedicare AdvantageMay 1, 2024

Gloversville Enlarged School District moves to Medicare Advantage plan from Anthem

Policy Updates

Policy UpdatesMedicaidApril 24, 2024

Clinical Criteria updates — November 2023

Policy UpdatesMedicaidMarch 28, 2024

MCG Care Guidelines 27th edition update

Medical Policy & Clinical GuidelinesCommercialMay 1, 2024

Medical Policy and Clinical Guideline updates

Reimbursement PoliciesCommercialApril 3, 2024

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

Products & Programs

Federal Employee Program (FEP)CommercialMay 1, 2024

HEDIS tips: Adult Immunization Status (AIS-E)

PharmacyCommercialApril 9, 2024

Acquisition of Paragon Healthcare

PharmacyCommercialApril 24, 2024

Specialty pharmacy updates — May 2024

PharmacyCommercialMay 1, 2024

Clinical Criteria updates for specialty pharmacy

PharmacyMedicaidApril 16, 2024

Prior authorization updates for medications billed under the medical benefit

Columvi, Izervay, Rystiggo, Vyvgart Hytrulo, and Eylea HD

PharmacyMedicare AdvantageApril 8, 2024

Anthem expands specialty pharmacy precertification list

PharmacyCommercialMarch 1, 2024

Pharmacy information available on our provider website

PharmacyMedicaidMarch 26, 2024

Quarterly pharmacy formulary change notice

PharmacyMedicaidMarch 27, 2024

Prior authorization and specialty pharmacy medical step therapy requirements

Quality Management

Quality ManagementCommercialMedicaidMay 1, 2024

Take action to improve adolescent immunizations rates

NYBCBS-CDCRCM-056144-24

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