CommercialMedicare AdvantageMedicaid Managed CareApril 1, 2024

April 2024 Provider Newsletter

Featured Articles

WebinarsMedicaid Managed CareApril 1, 2024

You are invited: Behavioral health provider orientation

WebinarsMedicaid Managed CareApril 1, 2024

You are invited: General provider orientation

Education & TrainingCommercialApril 1, 2024

Blue High Performance Network

Administrative

AdministrativeCommercialApril 1, 2024

HCPCS to revenue code alignment for behavioral health

AdministrativeCommercialApril 1, 2024

Review your online provider directory information

AdministrativeMedicaid Managed CareJanuary 1, 2024

New resources available for ePRAF

AdministrativeMedicaid Managed CareMarch 13, 2024

Floor to in-network skilled nursing facility inpatient prior authorization process

AdministrativeCommercialApril 1, 2024

Emergency department protocol for Special Investigation Unit review

Digital SolutionsCommercialApril 1, 2024

Home Health Agency Capabilities Survey

Digital SolutionsCommercialMarch 22, 2024

Coming soon — digital-only authorization case status notifications

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareApril 1, 2024

April is National Minority Health Month and Stress Awareness Month

Education & TrainingCommercialMarch 12, 2024

Important reminder: The correct original claim number must be included if submitting a corrected claim

Education & TrainingMedicaid Managed CareApril 1, 2024

New digital learning platform

Education & TrainingMedicaid Managed CareMarch 1, 2024

You are invited: Cultural competency and patient engagement

Policy Updates

Policy UpdatesMedicaid Managed CareMarch 25, 2024

Clinical Criteria updates — September 2023

Medical Policy & Clinical GuidelinesCommercialApril 1, 2024

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Medical Policies and Clinical Guidelines updates — April 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Prior AuthorizationMedicaid Managed CareApril 1, 2024

Prior authorization for pharmacogenomic testing

Prior AuthorizationMedicaid Managed CareMarch 12, 2024

Prior authorization requirement changes effective May 1, 2024

Prior AuthorizationMedicare AdvantageMarch 11, 2024

Prior authorization requirement changes effective July 1, 2024

Prior AuthorizationCommercialMarch 27, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Prior AuthorizationCommercialMedicare AdvantageMarch 20, 2024

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationMedicaid Managed CareApril 1, 2024

Notification of substance use disorder residential admissions

Reimbursement PoliciesCommercialApril 1, 2024

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Reimbursement policy update: Virtual Visits — Professional and Facility

Products & Programs

PharmacyMedicaid Managed CareMarch 22, 2024

Prior authorization updates for medications billed under the medical benefit

Elrexfio, Ngenla, Pombiliti, Talvey, Tyruko, Veopoz, and Ycanth

PharmacyMedicaid Managed CareMarch 6, 2024

Prior authorization updates for medications billed under the medical benefit

Elfabrio, Epkinly, Qalsody, Vyjuvek and Zynyz

PharmacyMedicare AdvantageMarch 22, 2024

Expansion of specialty pharmacy precertification list

Quality Management

Quality ManagementCommercialMedicare AdvantageMarch 8, 2024

HEDIS® 2024 documentation for Colorectal Cancer Screening (COL-E)

Quality ManagementMedicaid Managed CareMarch 8, 2024

HEDIS® 2024 documentation for Colorectal Cancer Screening (COL-E)

OHBCBS-CDCRCM-053375-24

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