CommercialMedicare AdvantageMedicaid Managed CareSeptember 1, 2024

September 2024 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageAugust 28, 2024

Maximizing care with regular provider data attestation

AdministrativeCommercialMedicare AdvantageAugust 1, 2023

Clinical Laboratory Improvement Amendments

AdministrativeMedicaid Managed CareSeptember 1, 2024

Provider revalidations


Administrative

AdministrativeMedicaid Managed CareSeptember 1, 2024

Reconsideration process for pre-service or concurrent inpatient stay

AdministrativeMedicare AdvantageMedicaid Managed CareSeptember 1, 2024

Drug and biologic

AdministrativeMedicaid Managed CareSeptember 1, 2024

Understanding the Ohio Medicaid fee schedule for chiropractic claims

AdministrativeMedicaid Managed CareSeptember 1, 2024

Behind the scenes, get to know: Ellen Woodard 

AdministrativeMedicaid Managed CareJanuary 1, 2024

New resources available for ePRAF

AdministrativeMedicaid Managed CareAugust 1, 2024

Access instant health plan information via Availity Essentials

Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareAugust 28, 2024

Advancing digital efficiency by discontinuing paper remittances

Digital SolutionsMedicare AdvantageMedicaid Managed CareAugust 13, 2024

Coming soon — digital-only authorization case status notifications

Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareSeptember 1, 2024

Save time and get better results with optimized CPT code search in Availity Essentials

Education & Training

Education & TrainingMedicaid Managed CareSeptember 1, 2024

Join our Provider Advisory Council

Education & TrainingCommercialSeptember 1, 2024

New provider resource for family caregivers of members with cancer

WebinarsMedicaid Managed CareSeptember 1, 2024

You are invited: Skilled nursing facility webinar

WebinarsMedicaid Managed CareAugust 1, 2024

You are invited: Behavioral Health provider orientation

WebinarsMedicaid Managed CareAugust 1, 2024

You are invited: Hospice education webinar

WebinarsMedicaid Managed CareAugust 1, 2024

You are invited: Provider orientation

Policy Updates

Policy UpdatesMedicaid Managed CareAugust 1, 2024

Clinical Criteria updates

Effective September 7, 2024

Medical Policy & Clinical GuidelinesCommercialAugust 14, 2024

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

Medical Policies and Clinical UM Guidelines updates — September 2024

Prior AuthorizationMedicaid Managed CareAugust 5, 2024

Prior authorization requirement changes

Effective October 1, 2024
Codes: 33263, 33264, 64582, and C2616

Prior AuthorizationMedicare AdvantageJuly 31, 2024

Prior authorization requirement changes

Effective December 1, 2024

Prior AuthorizationMedicaid Managed CareSeptember 1, 2024

New Carelon Medical Benefits Management, Inc. programs effective December 1, 2024

Prior AuthorizationMedicaid Managed CareSeptember 1, 2024

Reminder: PDN and HHC prior authorization requests

Products & Programs

Federal Employee Program (FEP)CommercialJuly 31, 2024

FEP Quality Reimbursement Program for providers

Long-Term Services & SupportsCommercialSeptember 1, 2024

The Power of the Blues: Introducing the Blue National Physician Performance Dataset

PharmacyCommercialAugust 26, 2024

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

Specialty pharmacy updates — September 2024

PharmacyMedicare AdvantageAugust 12, 2024

Anthem expands specialty pharmacy precertification list

Code: J1599

PharmacyMedicare AdvantageAugust 27, 2024

Anthem expands specialty pharmacy precertification list

Codes: C9399, J9999 and J3590

PharmacyMedicare AdvantageSeptember 1, 2024

Real-time prescription benefit

PharmacyCommercialSeptember 1, 2024

Pharmacy information available on our provider website

Quality Management

Quality ManagementCommercialMedicare AdvantageAugust 13, 2024

Announcing the new HEDIS documentation library supporting coding excellence

OHBCBS-CDCRCM-065311-24

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