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Bulletins

• View the latest updates to Medical Clinical Policies

• National Epic Payer Platform Announcement
• Important Pharmacy Claims Processing Change, Effective January 1, 2024
• Medicare Prior Authorization Changes Effective October 1, 2023
• Annual Special Needs Plan Model of Care (MOC) Training
• Reminder: Home Health Notice of Admission (NOA) Change
• COVID-19 Public Health Emergency (PHE) Expiration - Effective May 11, 2023
• Medicare Prior Authorization Change Summary - Effective July 1, 2023
• Appendix A - Medicare Part B Drug List - Effective July 1, 2023
• Reminder of CMS Lab Ordering Guidelines
• Wellcare 2023 $0 Immunizations Part D Vaccines - (PDF)
• Special Needs Plan Model of Care Self-Study Program
• Medicare Part B Drugs List: Effective January 1, 2023 (Appendix A)
• Medicare Prior Authorization Change Summary: Effective January 1, 2023
• CMS Lab Ordering Guidelines Reminder
• nterQual Criteria Rollout: Effective August 1, 2022
• Prior Authorization Change Summary: Effective July 1, 2022
• Prior Authorization Requirement Updates: Effective March 1, 2022
• Wellcare’s Provider Portal – Now with Improved Live Chat
• Point of Care Formulary Information Tools
• CPP 161: Polymerase Chain Reaction Respiratory Viral Panel Testing
• Claims and Payment Policy: Review of NOS, NEC, & Unlisted Codes
• Provider IVR Claims Menu Redesign
• New Portal Features: iCarePath Claim Appeals and Disputes
• New Prepay Edits: Institutional Ambulance Claims
• Prepayment Clinical Validations Edit Policy
• CPP 151: Frequency of Comprehensive Ophthalmological Exams
• New Secure Provider Portal Features Available
• CPP 145: Incorrect Billing for Severe Malnutrition Policy
• $0 Member Liability extended for select services until end of 2020
• Opioid Program MAT Certification
• CPP 133: 340B Drug Payment Reduction Policy
• Prior Authorization Updates: Wound Care & Skin Substitutes
• Wellcare and Managed Health Services
• Intensity-Modulated Radiation Therapy (IMRT) Reimbursement Policy
• Reducing Low Value Care Screenings Claims Edit Guidelines Policy
• DSNP Coinsurance Place of Service Code 22 Update
• ED High Acuity Radiology Utilization Reimbursement Policy
• Medicare Milliman Clinical Guidelines (MCG) Rollout
• New Urine Drug Testing Guidelines
• Prior Authorization Requirements
• Medicare Star Ratings Call to Action
• Annual Wellness Visit and Additional Physical Coding Refresher
• Readmission Policy Update
• New Modifier Claims Edit Guideline (CEG)
• Prior Authorization Requirements
• Dual SNP Cost Share Update
• Important update to Post-Acute Care CCG
• HealthHelp
• New Medicare Cards
• Exciting Authorization Rule Enhancements
• Your Partner in Quality Care
• Provider Notice of Wellcare/DaVita Contract Termination Recension
• Achievements in Clinical Excellence (ACE) Program Discontinuation
• Pharmacy Benefit Manager Effective January 1, 2016
• ICD-10 Transition Effective October 1, 2015
• Coding Reminder
• Inpatient Readmissions Policy

• View the latest updates to Medical Clinical Policies