CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2024

July 2024 Provider Newsletter

Featured Articles

Digital SolutionsMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2024

Admission, discharge, and transfer information is now available for Medicare Advantage and Medicaid members

Administrative

AdministrativeCommercialJuly 1, 2024

Drugs and biologic

AdministrativeCommercialJuly 1, 2024

Timely receipt of other carrier EOB or rejection helps avoid timely filing denials

AdministrativeCommercialJuly 1, 2024

Anesthesia modifiers — professional editing update

AdministrativeCommercialJuly 1, 2024

Recovery room — facility editing update

AdministrativeCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 18, 2024

Phoenix Sepsis Criteria for coding and billing pediatric sepsis

AdministrativeCommercialJuly 1, 2024

CAA: Maintain your online provider directory information

Digital SolutionsCommercialJune 13, 2024

Digital-only authorization case status notification coming to you

Education & Training

Education & TrainingCommercialJune 13, 2024

Faster notification of EDI corrected claims errors

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

July is Disability Awareness Month

Education & TrainingCommercialMarch 12, 2024

Important reminder: The correct original claim number must be included if submitting a corrected claim

Policy Updates

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsMay 29, 2024

Clinical Criteria updates

Effective June 29, 2024

Policy UpdatesMedicare AdvantageJune 4, 2024

Clinical Criteria updates

Effective July 6, 2024

Policy UpdatesMedicare AdvantageJune 3, 2024

Clinical Criteria updates — November 2023

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsJune 4, 2024

Updated: Carelon Medical Benefits Management, Inc. updates

Policy UpdatesMedicare AdvantageMay 29, 2024

Carelon Medical Benefits Management, Inc. updates

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageJune 27, 2024

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

Medical Policy & Clinical GuidelinesCommercialJune 11, 2024

Medical Policies and Clinical Guidelines updates for July 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageMay 30, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2024

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 17, 2024

Medicaid DMEPOS UM program

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 11, 2024

Prior authorization requirement changes

Effective August 1, 2024
Codes 81173, 81247, 81249, 81307, 81336, 81403, 81405, and 81440

Reimbursement PoliciesCommercialJuly 1, 2024

Reimbursement policy update: Incident to Services — Professional

Reimbursement PoliciesCommercialJuly 1, 2024

Reimbursement policy update: Frequency Editing — Professional

Reimbursement PoliciesCommercialJuly 1, 2024

New reimbursement policy: Multiple Surgery — Facility

Reimbursement PoliciesCommercialJuly 1, 2024

New Reimbursement policy: Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and Facility

Products & Programs

Federal Employee Program (FEP)CommercialJuly 1, 2024

Antidepressant Medication Management (AMM)

PharmacyCommercialJuly 1, 2024

Correction: Specialty pharmacy updates — July 2024

PharmacyMedicare AdvantageJune 20, 2024

Anthem expands specialty pharmacy precertification list

PharmacyBadgerCare Plus and Medicaid SSI ProgramsJune 18, 2024

Prior authorization updates for medications billed under the medical benefit

Quality Management

Quality ManagementMedicare AdvantageJuly 1, 2024

Understanding your role in the Health Outcomes Survey

WIBCBS-CDCRCM-061292-24