CommercialMedicare AdvantageMedicaid Managed CareFebruary 1, 2024

February 2024 Provider Newsletter

Featured Articles

AdministrativeMedicaid Managed CareJanuary 29, 2024

Provider revalidations resumed; immediate action required

A message from Ohio Department of Medicaid

Administrative

AdministrativeCommercialFebruary 1, 2024

CAA: Have you reviewed your online provider directory information lately?

AdministrativeMedicaid Managed CareJanuary 18, 2024

Updated guidance for Immunizations Covered by Vaccines for Children (VFC)

AdministrativeMedicaid Managed CareFebruary 1, 2024

Filing hospice claims

AdministrativeMedicaid Managed CareJanuary 1, 2024

New resources available for ePRAF

Digital SolutionsCommercialFebruary 1, 2024

RETRACTED: Beginning in March 2024, you can submit Behavioral Health prior authorizations through the Authorization application on Availity.com

Education & Training

WebinarsMedicaid Managed CareFebruary 1, 2024

You are invited: Provider orientation

WebinarsMedicaid Managed CareFebruary 1, 2024

You are invited: Anthem Behavioral Health provider orientation

Policy Updates

Policy UpdatesCommercialFebruary 1, 2024

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

MCG care guidelines 27th edition update

Policy UpdatesMedicare AdvantageJanuary 18, 2024

Clinical Criteria updates — September 2023

Policy UpdatesMedicaid Managed CareJanuary 23, 2024

Carelon Medical Benefits Management, Inc. updates

Medical Policy & Clinical GuidelinesCommercialJanuary 24, 2024

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

Carelon Medical Benefits Management, Inc. genetic testing code updates

Medical Policy & Clinical GuidelinesMedicaid Managed CareJanuary 23, 2024

Medical Policies and Clinical Utilization Management Guidelines update for May 2023

Prior AuthorizationCommercialFebruary 1, 2024

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

Claims Match Enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing

Prior AuthorizationMedicaid Managed CareFebruary 1, 2024

Prior authorization requirement changes effective March 1, 2024

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes 0738T and 0739T

Prior AuthorizationMedicare AdvantageNovember 15, 2023

Prior authorization requirement changes effective May 1, 2024 

Codes Q4272 - Q4284

Prior AuthorizationMedicare AdvantageNovember 8, 2023

Prior authorization requirement changes effective May 1, 2024 

Code E0761

Prior AuthorizationCommercialFebruary 1, 2024

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

Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

Reimbursement PoliciesCommercialFebruary 1, 2024

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

New reimbursement policy: Modifier Usage — Facility

Products & Programs

PharmacyCommercialFebruary 1, 2024

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

Designated specialty pharmacy network updates

PharmacyCommercialJanuary 24, 2024

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

Specialty pharmacy updates — February 2024

PharmacyMedicare AdvantageJanuary 18, 2024

RETRACTED: Expansion of specialty pharmacy precertification list

Quality Management

Quality ManagementMedicare AdvantageFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementMedicaid Managed CareFebruary 1, 2024

Improving Hispanic heart health

Quality ManagementCommercialFebruary 1, 2024

Improving Hispanic heart health

OHBCBS-CDCRCM-048974-24