CommercialMedicare AdvantageMedicaid Managed CareDecember 1, 2024

December 2024 Provider Newsletter

Featured Articles

AdministrativeMedicaid Managed CareSeptember 1, 2024

Provider revalidations

Digital SolutionsCommercialMedicare AdvantageNovember 1, 2024

Roster Automation updates: roster download functionality


Administrative

AdministrativeMedicare AdvantageNovember 18, 2024

Ohio 2025 Medicare Advantage plan changes

AdministrativeCommercialDecember 1, 2024

Case Management program

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

AdministrativeMedicaid Managed CareDecember 1, 2024

Behind the scenes, get to know: Chrissy Burns 

AdministrativeCommercialDecember 1, 2024

Coordination of care

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

AdministrativeCommercialDecember 1, 2024

Important information about utilization management

AdministrativeMedicaid Managed CareJanuary 1, 2024

New resources available for ePRAF

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Behavioral Health

Behavioral HealthCommercialMedicare AdvantageDecember 1, 2024

Comprehensive, holistic care for obstructive sleep apnea

Education & Training

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

Education & TrainingMedicaid Managed CareSeptember 1, 2024

Join our Provider Advisory Council

WebinarsMedicaid Managed CareDecember 1, 2024

You are invited: doula orientation

Policy Updates

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Medical Policy & Clinical GuidelinesMedicaid Managed CareNovember 21, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 1, 2025

Prior AuthorizationMedicaid Managed CareNovember 12, 2024

Prior authorization requirement changes

Effective January 1, 2025

Reimbursement PoliciesCommercialDecember 1, 2024

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

New reimbursement policy: Trauma Activation — Facility

Products & Programs

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Federal Employee Program (FEP)CommercialDecember 1, 2024

FEP excited to join PSHB program in 2025

PharmacyCommercialDecember 1, 2024

Pharmacy information available online

PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

PharmacyCommercialNovember 18, 2024

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

Specialty pharmacy updates — December 2024

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