CommercialMedicare AdvantageMedicaid Managed CareMay 1, 2024

May 2024 Provider Newsletter

Featured Articles

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareMay 1, 2024

Digital Request for Additional Information is now available for all lines of business


Administrative

AdministrativeCommercialMay 1, 2024

CAA: Maintain your online provider directory information

AdministrativeCommercialMay 1, 2024

Inaccurate laterality and diagnosis combination

AdministrativeMedicare AdvantageMedicaid Managed CareMay 1, 2024

Inaccurate laterality and diagnosis combination

AdministrativeCommercialApril 24, 2024

Notice of readmission processing change

AdministrativeMedicaid Managed CareMay 1, 2024

Behind the scenes, get to know: Janene Jacobs

AdministrativeMedicaid Managed CareJanuary 1, 2024

New resources available for ePRAF

AdministrativeCommercialMay 1, 2024

Provider manual updates to become effective August 1, 2024

Digital SolutionsMedicare AdvantageMedicaid Managed CareApril 26, 2024

Introducing new functionality for non-medical providers

Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareApril 15, 2024

Coming soon — Submit behavioral health authorizations through the Authorization application on Availity

Digital SolutionsCommercialApril 23, 2024

Overview of the Preference Center on Availity Essentials

Digital SolutionsCommercialMedicare AdvantageMay 1, 2024

Roster automation update

Digital SolutionsMedicare AdvantageMay 1, 2024

Personalized Match update

Education & Training

Education & TrainingCommercialApril 25, 2024

Instructions for donor claim billing

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareMay 1, 2024

Rotary to ground educational message

Education & TrainingMedicaid Managed CareMarch 31, 2023

Ready, set, renew!

WebinarsMedicaid Managed CareApril 1, 2024

You are invited: Behavioral health provider orientation

WebinarsMedicaid Managed CareApril 1, 2024

You are invited: General provider orientation

Policy Updates

Policy UpdatesMedicaid Managed CareApril 2, 2024

Clinical Criteria updates — August 2023

Policy UpdatesMedicaid Managed CareMarch 25, 2024

Clinical Criteria updates — November 2023

Policy UpdatesMedicaid Managed CareApril 2, 2024

Clinical Criteria updates — December 2023

Policy UpdatesMedicaid Managed CareApril 4, 2024

Carelon Medical Benefits Management, Inc. updates

Medical Policy & Clinical GuidelinesMedicaid Managed CareApril 22, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Reimbursement PoliciesMedicaid Managed CareApril 10, 2024

CPT Category II Code Additional Reimbursements for Ohio Medicaid Managed Care

Reimbursement PoliciesMedicaid Managed CareMay 1, 2024

New lab testing Clinical Guidelines

Products & Programs

Federal Employee Program (FEP)CommercialMay 1, 2024

HEDIS tips: Adult Immunization Status (AIS-E)

PharmacyMedicaid Managed CareApril 16, 2024

Prior authorization updates for medications billed under the medical benefit

Columvi, Izervay, Rystiggo, Vyvgart Hytrulo, and Eylea HD

PharmacyCommercialApril 24, 2024

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

Specialty pharmacy updates — May 2024

PharmacyCommercialMay 1, 2024

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

Designated specialty pharmacy network updates

PharmacyCommercialMarch 1, 2024

Pharmacy information available on our provider website

PharmacyCommercialApril 9, 2024

Acquisition of Paragon Healthcare

PharmacyMedicare AdvantageApril 8, 2024

Anthem expands specialty pharmacy precertification list

Quality Management

Quality ManagementCommercialMedicaid Managed CareMay 1, 2024

Take action to improve adolescent immunizations rates

OHBCBS-CDCRCM-056146-24

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