CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

August 2024 Provider Newsletter

Featured Articles

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

MCG Care Guidelines 28th edition


Administrative

AdministrativeMedicare AdvantageAugust 1, 2024

ICD-10-CM Excludes1 notes

AdministrativeCommercialAugust 1, 2024

Device-dependent procedures — facility editing update

AdministrativeBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

Access to care standards reminder

Digital SolutionsCommercialJuly 24, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsMedicare AdvantageJuly 16, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

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

Behavioral Health

Behavioral HealthBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

Learn to Live: A Digital Mental Health Benefit for Anthem members!

Education & Training

Education & TrainingCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

Coming soon: Provider e-Learning Resource Center for Payment Integrity

Education & TrainingCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

August is National Breastfeeding Month

Policy Updates

Policy UpdatesMedicare AdvantageJuly 10, 2024

Clinical Criteria updates

Effective August 12, 2024

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsJune 27, 2024

Carelon Medical Benefits Management, Inc. updates effective October 20, 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Medical Policy & Clinical GuidelinesCommercialJuly 11, 2024

Material adverse change

Medical Policies and Clinical Guidelines updates — August 2024

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsJune 28, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after October 20, 2024

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsJuly 19, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after November 17, 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 11, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after November 17, 2024

Medical Policy & Clinical GuidelinesCommercialAugust 1, 2024

Material adverse change

Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines

Effective for dates of service on and after November 17, 2024

Prior AuthorizationCommercialAugust 1, 2024

Notification of authorization fax number changes

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 27, 2024

Prior authorization requirement changes 

Effective August 1, 2024
Code L7510

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 26, 2024

Prior authorization requirement changes

Effective August 1, 2024
Code C9790

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 27, 2024

Prior authorization requirement changes 

Effective August 1, 2024
Code L5615

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

New reimbursement policy: Intraoperative Neuromonitoring — Professional

Reimbursement PoliciesCommercialAugust 1, 2024

Reimbursement policy update: Modifiers 26 and TC — Professional

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Professional Anesthesia Service

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Bundled Services and Supplies — Facility

Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Outpatient Facility Revenue Code Billing Requirements — Facility

Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Reimbursement PoliciesBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

PharmacyCommercialJuly 25, 2024

Material adverse change

Specialty pharmacy updates — February 2024

Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.

PharmacyCommercialAugust 1, 2024

Material adverse change

Specialty pharmacy updates — August 2024

Tevimbra, Tyenne, and Wezlana


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