These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. The changes will also be included in the next update of our Provider Manual. ...
Updates on Existing Criteria
August 2023. The following changes to criteria are effective August 22, 2023:
Prior Authorization Criteria – Clinical Updates...
The COVID-19 National Emergency and PHE ended on May 11, 2023. Our FAQ provides a brief overview of changes for Medicare and Medicaid providers.
The FAQ includes:
Answers to general questions
An...
Updates on Existing Criteria
July 2023. The following changes to criteria are effective July 22, 2023:
Prior Authorization Criteria – Clinical Updates
...
Beginning May 15, 2023, PacificSource Health Plans will use the CMS/National Correct Coding Initiative (NCCI) designation for the consideration of C-code reimbursements....
As of March 24, 2023, Carelon Medical Benefits Management (formerly AIM Specialty Health) will review prospective and retroactive authorizations up to 60 calendar days from the date of...
Updates on Existing Criteria
June 2023. The following changes to criteria are effective June 22, 2023:
Prior Authorization Criteria – Clinical Updates
...
After a three-year pause, the process of checking member eligibility for renewing Medicaid health insurance coverage has begun again. It’s estimated that anywhere between 5 and 15 million people are...