The February edition of the UHC Network News is now available for review by following the link below.

UHC Network News

Home State Health – Policy Update – Testing for Select Genitourinary Conditions 051524

Dear Provider,

Thank you for your continued partnership with Home State Health.

As you know, we continually review and update our payment and clinical policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members.

We write to inform you of updates to Home State Health’s Testing for Select Genitourinary Conditions clinical policy. These updates will be effective for Medicaid, Marketplace and Medicare plans effective May 15, 2024.

Arkansas BCBS – Providers News February 2024

This month’s featured articles:

• Post-Service Pre-Pay Review of Claims
• Organizational Determination/Benefit Inquiry
• Inpatient Admissions
• Inpatient Prior Authorization and Organizational Determination/Benefit Inquiry Requests
• Outpatient Prior Authorization and Organizational Determination/Benefit Inquiry Requests
• Specialty Medicine Prior Authorization and Organizational Determination/Benefit Inquiry Requests
• Prior Authorization Reminder
• Tyson Run Out
• Insurance Card Logo Examples
• Octave: The New Brand for Individual Coverage
• PaymodeX and Bottomline Technologies emails are legitimate

Anthem Provider Newsletter – Missouri February 2024

This month’s featured articles:

Administrative

• Home Health Agency Capabilities Survey
• CAA:Have you reviewed your online provider directory information lately?
• Beginning in March 2024, you can submit Behavioral Health prior authorizations through the Authorization application on Availity.com
• Update: Training for digital requests for additional information (Digital RFAI)

Policy Updates

• MCG care guidelines 27th edition update
• Clinical Criteriaupdates — September 2023

Medical Policy & Clinical Guidelines

• Carelon Medical Benefits Management, Inc. genetic testing code updates

Prior Authorization

• Claims Match Enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing
• Prior authorization requirement changes effective May 1, 2024 

Reimbursement Policies

• New reimbursement policy: Modifier Usage — Facility
• Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

Pharmacy

• Updated requirements to obtain certain specialty drugs from CVS Specialty Pharmacy
• Specialty pharmacy updates — February 2024
• Expansion of specialty pharmacy precertification list

Quality Management

• Improving Hispanic heart health

HealthChoice Provider Network News – Winter 2024

In this issue

• Claim denials needing medical records
• Corrected claims
• Direct data entry of claims and group numbers
• Fee schedules
• Fee schedule updates
• HealthChoice contact information

The February edition of the Medica Connections is now available for review by opening the attached file.

*Reminder to verify the plan type and location listed

Feb2024Conn – Final

The following topics are covered in this edition.

General News

• Wellness Corner:  Seven ways exercise helps the heart.

Clinical News

• Annual Chart Review coming soon for HEDIS quality reporting

Pharmacy News

• Site of Service drug-infusion program expanded to include Briumvi effective 01/01/2024
• Two preferred biosimilars added to long-acting GCSF drug class effective 01/01/2024
• Medica to add new UM policies for 5 new medical pharmacy drugs effective 04/01/2024

Network News

• Effective 04/01/2024 Medica will implement their annual IFB physician fee schedule updates

Administrative News

• Provider administrative training webinar for February: Claim Appeals, Adjustments and Record Submission.  This is scheduled for February 15th 12:00pm – 1pm CST.  The registration link and additional information can be found on the attachment.

This is a reminder that the current Healthy Blue Medicaid Newsletters can be accessed by following this link:

Provider News

UHC has provided two links that will provide you with additional resources for the 2024 Exchange plans.

This link takes you to an interactive guide that provides an overview of these plans.

UHC Exchange Plans Interactive Guide

This link will take you to the Exchange plan website on UHC.com.

Individual Exchange Plans

Home State Health will be offering a TF-CBTWeb 2.0 training course from 8:30 – 5:00 CT March 21-22, 2024.  There are specific items that need to be completed by March 8th before you can register.  Full details are available by following the link below.  This event also has the potential to provide CE credit.

Home State Virtual TF-CBT Training

Cigna Reimbursement Policy Update – 3D Rendering Billed with 76377

As a result of a recent review, we will administratively, deny Current Procedural Terminology (CPT®) code 76377 as incidental, consistent with the process in place for  CPT code 76376. Denials will affect the claim line only and include administrative appeal rights.

We will update the Omnibus Reimbursement Policy (R24) to reflect this change. This update is effective for dates of service on or after April 14,
2024.