Every day, our providers help us deliver effective care, delivered in a safer environment at a better value.
Effective February 12, 2024 and retroactive August 17, 2020 pre-authorization for trisomy 13, 18, 21, X and Y tests. To be covered, testing must comply with the most recent American College of Obstetricians and Gynecologists guidelines. Coverage for singleton pregnancies with a high risk of fetal aneuploidy is limited to claims dated to March 5, 2015 through August 16,2020.
Please view the attachment below for full details.
The March edition of the Medica Connections is now available for review by following the link below.
*Reminder to verify the plan type and location listed
The following topics are covered in this edition.
General News
Clinical News
Pharmacy News
Network News
Administrative News
FEBRUARY 2024
Learn more about: Risk Adjustment Documentation and Coding
Each webinar includes an overview of Risk Adjustment (RA) and Hierarchical Condition Categories (HCCs).
Click on the following link for more information and registration.
We routinely review our coverage, reimbursement, and administrative policies for potential updates. In that review, we take into consideration one or more of the following: evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services guidance, industry standards, and our other existing policies.
As a result of a recent review, we will update the Code Editing Policy & Guidelines to add 10 codes with a status B indicator: Current Procedural Terminology codes 38204, 92921, 92925, 92929, 92934, 92938, 92944, and 97602 and Healthcare Common Procedure Coding System codes A4262 and A4263. These codes will be administratively denied when billed with another service not indicated as bundled.
Denials will affect the claim line only and include administrative appeal rights. This update is effective for dates of service on or after May 11, 2024.
This is a reminder from HNFS regarding their progress note requirements under their Autism Care Demonstration program. The notes bust contain all Tricare-required elements, support the respective claim and relate to the beneficiary’s approved treatment plan goals.
Full details can be found on the attachment.
The February edition of the UHC Network News is now available for review by following the link below.
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.
| Policy Number | Policy Name | Policy Description |
| CP.MP.97 | Testing for Select Genitourinary Conditions | Revisions Include:
|
Arkansas BCBS – Providers News February 2024
This month’s featured articles:
Anthem Provider Newsletter – Missouri February 2024
This month’s featured articles:
Administrative
Policy Updates
Medical Policy & Clinical Guidelines
Prior Authorization
Reimbursement Policies
Pharmacy
Quality Management