CommercialMedicare AdvantageMedicaid Managed CareMarch 1, 2024

March 2024 Provider Newsletter

Administrative

AdministrativeMedicaid Managed CareJanuary 1, 2024

New resources available for ePRAF

AdministrativeMedicare AdvantageMarch 1, 2024

CAA: Maintain your online provider directory information

AdministrativeMedicaid Managed CareMarch 1, 2024

Billing guidelines for Medicaid behavioral health providers

AdministrativeMedicaid Managed CareJanuary 29, 2024

Provider revalidations resumed; immediate action required

A message from Ohio Department of Medicaid

Digital SolutionsMedicaid Managed CareMarch 1, 2024

Availity Essentials Patient360

Digital SolutionsCommercialMarch 1, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsMedicare AdvantageFebruary 29, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Digital SolutionsMedicaid Managed CareMarch 1, 2024

Behind the scenes, get to know: Danielle Clark

Education & Training

Education & TrainingCommercialMedicaid Managed CareMarch 1, 2024

Congenital syphilis intervention opportunities for neonatal and pediatric providers

Education & TrainingMedicaid Managed CareMarch 1, 2024

You are invited: Cultural competency and patient engagement

Education & TrainingMedicaid Managed CareMarch 1, 2024

Resources to support your diverse patient panel

Policy Updates

Policy UpdatesMedicaid Managed CareMarch 1, 2024

MCG Care Guidelines 28th edition

Medical Policy & Clinical GuidelinesMedicare AdvantageFebruary 20, 2024

Clinical Criteria updates — December 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 1, 2024

Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior AuthorizationMedicare AdvantageFebruary 1, 2024

Prior authorization requirement changes effective May 1, 2024

Codes G0481 - G0483

Prior AuthorizationMedicare AdvantageJanuary 24, 2024

Prior authorization requirement changes effective May 1, 2024

Code C1825

Reimbursement PoliciesCommercialMarch 1, 2024

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

Reimbursement policy update: Ambulance Transportation – Professional

Products & Programs

PharmacyMedicare AdvantageMarch 1, 2024

Overview of Medicare risk adjustment in-office prospective programs

PharmacyMedicare AdvantageFebruary 16, 2024

Anthem expands specialty pharmacy precertification list

PharmacyCommercialFebruary 20, 2024

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

Prior authorization updates for therapeutic duplication of specialty drugs

PharmacyCommercialMarch 1, 2024

Pharmacy information available on our provider website

PharmacyMedicaid Managed CareFebruary 21, 2024

Prior authorization updates for medications billed under the medical benefit

PharmacyCommercialFebruary 22, 2024

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

Specialty pharmacy updates — March 2024

PharmacyMedicare AdvantageJanuary 31, 2024

Notification of specialty pharmacy medical step therapy updates

Quality Management

Quality ManagementMedicare AdvantageFebruary 7, 2024

HEDIS® 2024 documentation for Care of Older Adults (COA)

Quality ManagementCommercialMedicare AdvantageMedicaid Managed CareFebruary 6, 2024

HEDIS 2024 documentation for Controlling High Blood Pressure (CBP) and Statin Therapy for Patients with Cardiovascular Disease (SPC)

Quality ManagementCommercialMedicaid Managed CareMarch 1, 2024

Cervical Cancer Screening (CCS) and Prenatal and Postpartum Care (PPC) for HEDIS

Quality ManagementCommercialMedicaid Managed CareMarch 1, 2024

Encourage Cervical Cancer Screening (CCS)

Quality ManagementCommercialMedicare AdvantageMedicaid Managed CareJanuary 29, 2024

HEDIS Breast Cancer Screening (BCS) update

OHBCBS-CDCRCM-051147-24

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).