CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2023
December 2023 Provider Newsletter
Featured Articles
CommercialDecember 1, 2023
CarelonRx, Inc. Mail will change to CarelonRx Pharmacy on January 1, 2024
Medicare AdvantageDecember 1, 2023
Model of care training reminder
Administrative
Medicare AdvantageNovember 1, 2023
Updates to correct coding editingCommercialDecember 1, 2023
New vendor administering Primary Care Access SurveyCommercialDecember 1, 2023
New vendor administering behavioral health access surveyCommercialDecember 1, 2023
Outpatient system updates for 2024CommercialDecember 1, 2023
Professional system updates for 2024CommercialDecember 1, 2023
Important information about utilization managementCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2023
New requirements for credentialing and recredentialingCommercialDecember 1, 2023
Case Management ProgramCommercialDecember 1, 2023
Coordination of careCommercialDecember 1, 2023
CAA: Review your online provider directory informationCommercialDecember 1, 2023
Clinical practice and preventive health guidelinesCommercialDecember 1, 2023
Members’ Rights and ResponsibilitiesCommercialDecember 1, 2023
Clinical Documentation Lookup ToolCommercialNovember 21, 2023
Process for Carelon Post Acute Solutions, LLC redirection and Availity Essentials clinical denial/approval outcome notificationsBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2023
Filing digital claims disputes: Transparent and trackablePolicy Updates
Medicare AdvantageNovember 21, 2023
Medical Policies and Clinical Utilization Management Guidelines update for May 2023BadgerCare Plus and Medicaid SSI ProgramsNovember 21, 2023
Medical Policies and Clinical Utilization Management Guidelines update for May 2023CommercialDecember 1, 2023
Medical Policies and Clinical Guidelines updates — December 2023CommercialDecember 1, 2023
Medical Policies and Clinical Guidelines updates — December 2023Medicare AdvantageDecember 1, 2023
Glucagon-Like Peptide-1 prior authorization changesBadgerCare Plus and Medicaid SSI ProgramsNovember 22, 2023
Carelon Medical Benefits Management, Inc. updates — November 2023BadgerCare Plus and Medicaid SSI ProgramsNovember 7, 2023
Carelon Medical Benefits Management, Inc. updatesCommercialOctober 27, 2023
Transition to Carelon Medical Benefits Management, Inc. Genetic Testing GuidelinesMedicare AdvantageNovember 20, 2023
Transition to Carelon Medical Benefits Management, Inc. Genetic Testing GuidelinesBadgerCare Plus and Medicaid SSI ProgramsOctober 31, 2023
Prior authorization update - IdacioMedicare AdvantageNovember 15, 2023
Prior authorization requirement changes effective May 1, 2024Codes Q4272 - Q4284
Medicare AdvantageNovember 15, 2023
Prior authorization requirement changes effective May 1, 2024Codes 0738T and 0739T
Medicare AdvantageOctober 31, 2023
Prior authorization requirement changes effective March 1, 2024Codes 33275 and 33274
Medicare AdvantageNovember 8, 2023
Prior authorization requirement changes effective May 1, 2024Code E0761
Products & Programs
CommercialDecember 1, 2023
Introducing the High Performing Provider designationCommercialDecember 1, 2023
Federal Employee Program updates member ID cardsMedicare AdvantageDecember 1, 2023
2024 Federal Employee Program Benefit information available onlineCommercialNovember 1, 2023
Pharmacy information available on our provider websiteMedicare AdvantageOctober 26, 2023
Notification of specialty pharmacy medical step therapy updatesQuality Management
BadgerCare Plus and Medicaid SSI ProgramsNovember 13, 2023
HEDIS 2023 Electronic Clinical Data Systems (ECDS)CommercialMedicare AdvantageNovember 13, 2023
HEDIS 2023 Electronic Clinical Data Systems (ECDS)WIBCBS-CDCRCM-045280-23
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