CommercialMedicare AdvantageMedicaid Managed CareDecember 1, 2023
December 2023 Provider Newsletter
Featured Articles
Medicare AdvantageDecember 1, 2023
Model of care training reminder
CommercialDecember 1, 2023
CarelonRx, Inc. Mail will change to CarelonRx Pharmacy on January 1, 2024
Administrative
Medicaid Managed CareDecember 1, 2023
Behind the scenes, get to know: Madelaine CornMedicare AdvantageNovember 1, 2023
Updates to correct coding editingCommercialDecember 1, 2023
New vendor administering Primary Care Access SurveyCommercialDecember 1, 2023
New vendor administering behavioral health access surveyCommercialDecember 1, 2023
Outpatient system updates for 2024CommercialDecember 1, 2023
Professional system updates for 2024CommercialDecember 1, 2023
Important information about utilization managementCommercialDecember 1, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Notification about submitting itemized billsCommercialMedicare AdvantageDecember 1, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
New requirements for credentialing and recredentialingCommercialDecember 1, 2023
Coordination of careCommercialDecember 1, 2023
Case Management ProgramCommercialDecember 1, 2023
CAA: Review your online provider directory informationCommercialDecember 1, 2023
Clinical practice and preventive health guidelinesCommercialDecember 1, 2023
Members’ Rights and ResponsibilitiesCommercialDecember 1, 2023
Clinical Documentation Lookup ToolCommercialNovember 21, 2023
Process for Carelon Post Acute Solutions, LLC redirection and Availity Essentials clinical denial/approval outcome notificationsMedicaid Managed CareDecember 1, 2023
Filing digital claims disputes: Transparent and trackablePolicy Updates
Medicare AdvantageNovember 21, 2023
Medical Policies and Clinical Utilization Management Guidelines update for May 2023CommercialDecember 1, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — December 2023CommercialDecember 1, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — December 2023Medicare AdvantageDecember 1, 2023
Glucagon-Like Peptide-1 prior authorization changesMedicare AdvantageNovember 20, 2023
Transition to Carelon Medical Benefits Management, Inc. Genetic Testing GuidelinesCommercialOctober 27, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Transition to Carelon Medical Benefits Management, Inc. Genetic Testing GuidelinesMedicaid Managed CareOctober 31, 2023
Prior authorization update - IdacioMedicaid Managed CareNovember 6, 2023
Prior authorization requirement changes effective January 1, 2024Medicare AdvantageNovember 15, 2023
Prior authorization requirement changes effective May 1, 2024Codes 0738T and 0739T
Medicare AdvantageNovember 15, 2023
Prior authorization requirement changes effective May 1, 2024Codes Q4272 - Q4284
Medicare AdvantageNovember 8, 2023
Prior authorization requirement changes effective May 1, 2024Code E0761
Medicare AdvantageOctober 31, 2023
Prior authorization requirement changes effective March 1, 2024Codes 33275 and 33274
Products & Programs
CommercialDecember 1, 2023
Introducing the High Performing Provider designationCommercialDecember 1, 2023
Federal Employee Program updates member ID cardsMedicare AdvantageDecember 1, 2023
2024 Federal Employee Program Benefit information available onlineCommercialNovember 1, 2023
Pharmacy information available on our provider websiteMedicare AdvantageOctober 26, 2023
Notification of specialty pharmacy medical step therapy updatesQuality Management
Medicaid Managed CareNovember 13, 2023
HEDIS 2023 Electronic Clinical Data Systems (ECDS)CommercialMedicare AdvantageNovember 13, 2023
HEDIS 2023 Electronic Clinical Data Systems (ECDS)Medicaid Managed CareDecember 1, 2023
EPSDT: Connecting care providers and membersOHBCBS-CDCRCM-045278-23
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