CommercialMedicare AdvantageMedicaid Managed CareAugust 1, 2023

August 2023 Provider News

Featured Articles


Administrative

AdministrativeMedicaid Managed CareAugust 1, 2023

Clinical Laboratory Improvement Amendments

AdministrativeCommercialAugust 1, 2023

Unspecified diagnosis code of site and laterality

AdministrativeCommercialMedicare AdvantageAugust 1, 2023

Clinical Laboratory Improvement Amendments

AdministrativeMedicare AdvantageJuly 18, 2023

Urinary tract infection tool kits are on the way

AdministrativeMedicaid Managed CareAugust 1, 2023

Provider Orientation dates - Summer 2023

AdministrativeCommercialAugust 1, 2023

Federal Consolidated Appropriations Act (CAA) Gag Clause

AdministrativeCommercialAugust 1, 2023

CAA: Review your online provider directory information regularly

Digital SolutionsMedicaid Managed CareAugust 1, 2023

Claims escalation, disputes, and appeals process

Policy Updates

Policy UpdatesMedicare AdvantageJune 29, 2023

Clinical Criteria updates - March 2023

Medical Policy & Clinical GuidelinesCommercialJuly 21, 2023

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

Updates to Carelon Medical Benefits Management, Inc. Joint Surgery, Small Joint Surgery, and MSK Level of Care

Prior AuthorizationMedicare AdvantageJuly 25, 2023

Prior authorization requirement changes effective November 1, 2023

Prior AuthorizationMedicaid Managed CareJuly 14, 2023

PA and Step therapy update - Vegzelma

Prior AuthorizationMedicaid Managed CareJuly 13, 2023

Prior authorization requirement changes effective September 1, 2023

Prior AuthorizationMedicaid Managed CareJune 28, 2023

Prior authorization requirement changes effective August 1, 2023

Reimbursement PoliciesMedicaid Managed CareAugust 1, 2023

Technology Assisted Surgical Procedures

Reimbursement PoliciesMedicare AdvantageAugust 1, 2023

Technology Assisted Surgical Procedures

Products & Programs

PharmacyCommercialAugust 1, 2023

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

Specialty pharmacy updates - August 2023

PharmacyCommercialAugust 1, 2023

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

Specialty pharmacy updates - August 2023

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 AdvantageAugust 1, 2023

Healthy blood pressure recheck initiative

Quality ManagementMedicare AdvantageAugust 1, 2023

Healthy blood pressure recheck initiative

Quality ManagementMedicaid Managed CareAugust 1, 2023

Important information about utilization management

Quality ManagementMedicaid Managed CareAugust 1, 2023

Members’ Rights and Responsibilities

Quality ManagementMedicaid Managed CareAugust 1, 2023

Complex Case Management Program

Quality ManagementCommercialMedicare AdvantageMedicaid Managed CareJuly 17, 2023

Pharmacotherapy Management of COPD Exacerbation (PCE) HEDIS® Measure

Quality ManagementCommercialMedicaid Managed CareAugust 1, 2023

Congenital syphilis is a sentinel health event

OHBCBS-CDCRCM-030308-23

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Availity, LLC is an independent company providing administrative support services on behalf of the health plan. Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.