May 31, 2023
June 2023 Provider Newsletter
Featured Articles
CommercialMedicare AdvantageMay 31, 2023
Introducing Roster Automation to improve turnaround times and data accuracy
CommercialMay 31, 2023
Correction: Federal Employee Program® Quality Reimbursement program update
Administrative
CommercialSeptember 1, 2023
Consider a FIT kit for your patients aged 45 and older at average risk for colon cancerCommercialMay 31, 2023
CAA: Have you reviewed your online provider directory information lately?Medicaid Managed CareMay 24, 2023
Help your patients stay coveredMedicaid Managed CareMay 31, 2023
Prepay itemization bill reviewMedicaid Managed CareMay 31, 2023
Provider data on facility claimsMedicaid Managed CareMay 31, 2023
2023 Medicaid Chronic Condition Capture HandoutMedicaid Managed CareMay 18, 2023
Immunizations Covered by Vaccines for Children (VFC)Medicaid Managed CareMay 9, 2023
Provider Orientation Dates Summer 2023CommercialMay 31, 2023
Digital notifications are coming June 1, 2023Medicaid Managed CareMay 31, 2023
Reminders: Electronic Remittance Advice (835) and Electronic Claim Submissions (837)Education & Training
CommercialMedicaid Managed CareMay 31, 2023
Building Vaccine Confidence – A webinar hosted by PfizerMedicaid Managed CareMay 31, 2023
Connections Application WebinarPolicy Updates
CommercialMay 31, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
MCG Care Guidelines 27th EditionCommercialMay 31, 2023
HCPCS to revenue code alignment – Evaluation/ManagementMedicare AdvantageMay 31, 2023
MCG Care Guidelines 27th EditionMedicaid Managed CareMay 24, 2023
Clinical Criteria Updates for December 2022Medicaid Managed CareMay 2, 2023
MCG Care Guidelines 27th editionMedicare AdvantageMay 4, 2023
Clinical Criteria Updates December 2022Medicare AdvantageMay 11, 2023
Clinical Criteria Updates February 2023CommercialMay 31, 2023
Medical Policies and Clinical Guidelines Updates — June 2023*CommercialMay 31, 2023
Updates to Carelon Medical Benefits Management, Inc. advanced imaging, sleep disorder management, and spine surgery Clinical Appropriateness Guidelines*Medicare AdvantageMay 31, 2023
Medicare Part B Precert Expansion Briumvi LeqembiMedicare AdvantageMay 31, 2023
Medicare Part B Step Therapy VegzelmaCommercialMay 31, 2023
Program delay announcement authorizations for post-acute care services for commercial membersCommercialMay 31, 2023
Effective August 1, 2023, Carelon Medical Benefits Management, Inc. programs will expandCommercialMay 31, 2023
New reimbursement policy: Provider Preventable Conditions – Professional and Facility*CommercialMay 31, 2023
Reimbursement policy update: Bundled Services and Supplies — ProfessionalCommercialMay 31, 2023
Reimbursement policy update: Bundled Services and Supplies policy – Professional*Products & Programs
CommercialMay 31, 2023
Expansion of Back Pain Guide Program effective July 1, 2023CommercialMay 31, 2023
OBRA 93 claim filing for Federal Employee ProgramCommercialMay 31, 2023
BioPlus provider FAQCommercialMay 31, 2023
Specialty pharmacy updates – June 2023*CommercialMarch 1, 2023
Pharmacy information available on our provider websiteQuality Management
CommercialMedicare AdvantageMay 31, 2023
Patient Safety Skilled Nursing Facility (SNF) SurveyMedicaid Managed CareMay 31, 2023
Moving Toward Equity in Asthma CareMedicare AdvantageMay 2, 2023
Colorectal Cancer Screening (COL) and Care for Older Adults (COA) for HEDISMedicare AdvantageMay 22, 2023
SPC ExclusionsOHBCBS-CDCRCM-024899-23
* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. BioPlus Specialty Pharmacy is an independent company providing pharmacy services on behalf of the health plan.
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