CommercialMedicare AdvantageMedicaid Managed CareNovember 1, 2023

November 2023 Provider Newsletter

Featured Articles

Digital SolutionsCommercialOctober 31, 2023

Digital RFAI process improvements

Education & TrainingCommercialOctober 31, 2023

Practitioners’ rights during credentialing process


Administrative

AdministrativeMedicare AdvantageNovember 1, 2023

Updates to correct coding editing

AdministrativeMedicare AdvantageOctober 31, 2023

2024 Medicare Advantage service area and benefit updates

AdministrativeMedicare AdvantageNovember 1, 2023

Usage of liability modifiers

AdministrativeMedicaid Managed CareOctober 31, 2023

Billing for durable medical equipment

AdministrativeCommercialNovember 1, 2023

CAA: Maintain your online provider directory information

Digital SolutionsCommercialNovember 1, 2023

Filing digital claims disputes: Transparent and trackable

Education & Training

Education & TrainingMedicaid Managed CareOctober 18, 2023

Applied behavior analysis services

WebinarsMedicaid Managed CareOctober 31, 2023

Medicaid provider orientations

Policy Updates

Medical Policy & Clinical GuidelinesCommercialNovember 1, 2023

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

Medical Policies and Clinical Guidelines updates — November 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageNovember 1, 2023

Carelon Medical Benefits Management, Inc. updates — November 2023

Prior AuthorizationMedicare AdvantageOctober 19, 2023

Expansion of Carelon Medical Benefits Management, Inc. programs

Prior AuthorizationMedicaid Managed CareOctober 24, 2023

Prior authorization update - Lamzede, Lunsumio, Rebyota, etc.

Prior AuthorizationMedicare AdvantageOctober 16, 2023

RETRACTION: Prior authorization requirement changes effective February 1, 2024

Codes 32274 and 32275

Prior AuthorizationMedicare AdvantageOctober 3, 2023

Prior authorization requirement changes effective February 1, 2024 - code J1411

Prior AuthorizationCommercialSeptember 28, 2023

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

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

Reimbursement PoliciesCommercialOctober 31, 2023

Reimbursement policy update: Pharmaceutical Waste – Professional and Facility

Products & Programs

Federal Employee Program (FEP)CommercialNovember 1, 2023

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

Federal Employee Program specialty pharmacy prior authorization review

Federal Employee Program (FEP)CommercialNovember 1, 2023

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

FEP® Specialty Pharmacy prior authorization list

PharmacyCommercialNovember 1, 2023

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

Specialty pharmacy updates

PharmacyCommercialNovember 1, 2023

Pharmacy information available on our provider website

Quality Management

Quality ManagementMedicare AdvantageNovember 1, 2023

Controlling high blood pressure and HEDIS

Quality ManagementMedicaid Managed CareOctober 31, 2023

Controlling high blood pressure and HEDIS

Quality ManagementMedicaid Managed CareOctober 25, 2023

HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS)

Quality ManagementCommercialMedicare AdvantageOctober 25, 2023

HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS)

Quality ManagementCommercialMedicare AdvantageOctober 15, 2023

HEDIS medical record submission made easier with our Remote EMR Access Service

Quality ManagementMedicaid Managed CareOctober 15, 2023

HEDIS medical record submission made easier with our Remote EMR Access Service

Quality ManagementMedicaid Managed CareOctober 31, 2023

Healthy blood pressure recheck initiative

Quality ManagementMedicaid Managed CareOctober 31, 2023

HEDIS measurement year 2023 documentation for Transitions of Care (TRC)

Quality ManagementCommercialMedicare AdvantageNovember 1, 2023

HEDIS measurement year 2023 documentation for Transitions of Care (TRC)

Quality ManagementCommercialMedicare AdvantageSeptember 27, 2023

Be Antibiotics Aware: Protect your patients

Quality ManagementMedicare AdvantageNovember 1, 2023

Statin therapy end of year best practices

OHBCBS-CDCRCM-041576-23

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