November 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaNovember 2024. The following changes to criteria are effective November 22, 2024:Prior Authorization Criteria –...
Providers
Revised coding policies for Emergency Department outpatient facility Evaluation and Management
As part of our continued efforts to reinforce accurate coding practices, we are revising the current Emergency Department (ED) outpatient facility Evaluation and Management (E/M) coding reimbursement...
October 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaThe following changes to criteria are effective October 22, 2024:Prior Authorization Criteria – Clinical UpdatesArikayce...
New resource available for caregivers of Medicare patients with dementia
Often times, patients with Alzheimer's disease or other forms of dementia are supported by a family caregiver—a valuable part of the patient’s care team. Now, these caregivers have a new...
Pharmacy coverage updates, effective September 15, 2024 (Medicaid)
We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after September 15, 2024.Summary of changes...
September 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaSeptember 2024. The following changes to criteria are effective September 22, 2024:Prior...
August 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaAugust 2024. The following changes to criteria are effective August 22, 2024:Prior Authorization Criteria –...
July 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaJuly 2024. The following changes to criteria are effective July 22, 2024:Prior Authorization Criteria –...
Most Change Healthcare services restored
Clearinghouse services provided by Change Healthcare have been mostly restored, including eligibility status, remittance advice, and claims transmission, following a February cybersecurity event....
Information for HRSN service providers
Here’s what providers should know if they want to provide health-related social needs (HRSN) services.Qualifications and process for becoming an HRSN service providerTo become an HRSN service...