February 1, 2025

February 2025 Provider Newsletter

Administrative

AdministrativeCommercialJanuary 16, 2025

Submitting authorization for NICU services facilitates accurate and timely claims processing

AdministrativeCommercialMedicare AdvantageFebruary 1, 2025

New Communication Center added to Availity Essentials

AdministrativeMedicaid Managed CareJanuary 15, 2025

Updated billing guidance for hospice billing for nursing facility room and board (HCPC T2046) and ventilator/ventilator‑weaning services

AdministrativeCommercialFebruary 1, 2025

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

Medical records needed for accurate payment of certain facility inpatient claims

Education & Training

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Hospice webinar

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Medicaid provider orientation

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Behavioral health provider orientation

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Nursing facility webinar

Education & TrainingMedicaid Managed CareFebruary 1, 2025

Join our Provider Advisory Council

WebinarsMedicaid Managed CareJanuary 1, 2025

You are invited: Review the Value-Added Benefits and Social Determinants of Health program

Policy Updates

Policy UpdatesMedicaid Managed CareJanuary 28, 2025

Clinical Criteria updates

Effective March 1, 2025

Reimbursement PoliciesCommercialFebruary 1, 2025

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

Reimbursement policy update: Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and Facility

Reimbursement PoliciesCommercialFebruary 1, 2025

New reimbursement policy: Place of Service — Professional

Products & Programs

Federal Employee Program (FEP)CommercialFebruary 1, 2025

Corrected claim guidance for the Federal Employee Program®

Federal Employee Program (FEP)CommercialJanuary 14, 2025

Authorization for post‑acute care services for FEP members

PharmacyCommercialJanuary 27, 2025

Key formulary updates: effective January 1, 2025

PharmacyCommercialFebruary 1, 2025

Pharmacy information available on our provider website

PharmacyCommercialFebruary 1, 2025

Designated specialty pharmacy network updates

PharmacyMedicaid Managed CareJanuary 7, 2025

Prior authorization updates for medications billed under the medical benefit

Effective March 1, 2025
Kisunla and Piasky

PharmacyMedicaid Managed CareJanuary 8, 2025

New specialty pharmacy medical step therapy requirements

Quality Management

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Quality ManagementCommercialFebruary 1, 2025

Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)

OHBCBS-CDCRCM-076707-25