CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

June 2023 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

Introducing Roster Automation to improve turnaround times and data accuracy

Federal Employee Program (FEP)CommercialMay 31, 2023

Correction: Federal Employee Program® Quality Reimbursement program update


Administrative

AdministrativeBadgerCare Plus and Medicaid SSI ProgramsMay 24, 2023

Help your patients stay covered

AdministrativeBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

Member Rights’ and Responsibilities Statement

Digital SolutionsCommercialMay 31, 2023

Digital notifications are coming June 1, 2023

Education & Training

Education & TrainingCommercialBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

Building Vaccine Confidence – A webinar hosted by Pfizer

Policy Updates

Policy UpdatesCommercialMay 31, 2023

MCG Care Guidelines 27th Edition

Policy UpdatesCommercialMay 31, 2023

HCPCS to revenue code alignment – Evaluation/Management

Policy UpdatesMedicare AdvantageMay 31, 2023

MCG Care Guidelines 27th Edition

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsMay 2, 2023

MCG Care Guidelines 27th Edition

Policy UpdatesMedicare AdvantageMay 4, 2023

Clinical Criteria Updates December 2022

Policy UpdatesMedicare AdvantageMay 11, 2023

Clinical Criteria Updates February 2023

Medical Policy & Clinical GuidelinesCommercialMay 31, 2023

Medical Policies and Clinical Guidelines Updates — June 2023*
*Material adverse change (MAC)

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsMay 23, 2023

Transition to Carelon Medical Benefits Management, Inc. MRI Breast Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsMay 18, 2023

Medical Policies and Clinical Utilization Management Guidelines update

Prior AuthorizationMedicare AdvantageMay 31, 2023

Medicare Part B Precert Expansion Briumvi Leqembi

Prior AuthorizationMedicare AdvantageMay 31, 2023

Medicare Part B Step Therapy Vegzelma

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsMay 24, 2023

Prior Authorization Requirement Changes Effective July 1, 2023

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsMay 23, 2023

Prior Authorization Update for Briumvi, Elahere, Imjudo, Leqembi, Pedmark, Sunlenca, Tecvayli, Tzield

Reimbursement PoliciesCommercialMay 31, 2023

New reimbursement policy: Provider Preventable Conditions – Professional and Facility*
*Material adverse change (MAC)

Reimbursement PoliciesCommercialMay 31, 2023

Reimbursement policy update: Bundled Services and Supplies — Professional

Reimbursement PoliciesCommercialMay 31, 2023

Reimbursement policy update: Bundled Services and Supplies policy – Professional*
*Material adverse change (MAC)

Products & Programs

Products & ProgramsCommercialMay 31, 2023

Expansion of Back Pain Guide Program effective July 1, 2023

Products & ProgramsBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

Complex Case Management program

Federal Employee Program (FEP)CommercialMay 31, 2023

OBRA 93 claim filing for Federal Employee Program

PharmacyCommercialMarch 1, 2023

Pharmacy information available on our provider website

PharmacyCommercialMay 31, 2023

BioPlus provider FAQ

PharmacyCommercialMay 31, 2023

Specialty pharmacy updates – June 2023*
*Material adverse change (MAC)

Quality Management

Quality ManagementCommercialMedicare AdvantageMay 31, 2023

Patient Safety Skilled Nursing Facility (SNF) Survey

Quality ManagementMedicare AdvantageMay 2, 2023

Colorectal Cancer Screening (COL) and Care for Older Adults (COA) for HEDIS

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

Important information about utilization management

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsMay 31, 2023

Notification of Pregnancy Incentive Program discontinuation

Quality ManagementMedicare AdvantageMay 22, 2023

SPC Exclusions

WIBCBS-CDCRCM-024901-23

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

* CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the health plan. BioPlus Specialty Pharmacy is an independent company providing pharmacy services on behalf of the health plan.