Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - April 2021

Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

• Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual*
• Designated Specialty Pharmacy Network*
• Updates for specialty pharmacy are available*
• Medical policy and clinical guideline updates*
• Update: Clinical guideline adoption postponed*
• MCG Care Guidelines 25th Edition available*
• Updated guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNF) facilities
• Maximizing efficient, high quality COVID-19 screenings*
• New reimbursement policy: Newborn Inpatient Stays for facilities*