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Page Last Updated: 5/7/2019

 
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 ‭(Hidden)‬ Provider Updates
Name (for use in forms)TitleDateProvider-Update-YearMarketApproval Status
KYKY_CAID_ProviderManual.pdfAnthem Blue Cross and Blue Shield Medicaid Provider Manual2018KentuckyApproved
VAVA_MMP_PU_NewImagingMgmt.pdfNew Imaging Management Solution 2014Virginia, VA MMPApproved
KYKY_CAID_PU_AuthorizationNotification_July2014.pdfAuthorization Notification July 20142014KentuckyApproved
KYKY_CAID_PU_NewbornDiagnosisRelatedGroupPolicy.pdfNewborn Diagnosis-Related Group Policy2014KentuckyApproved
VAVA_CAID_RecontractingPharmacyNetwork.pdfNew Pharmacy Network2015VirginiaApproved
KYKY_CAID_PharmacyFormularyChangeNotice.pdfPharmacy Formulary Change Notice2014KentuckyApproved
KYKY_CAID_TaxonomyRequirements.pdfCMS-1500 Form & UB04 Taxonomy Code Requirements2014KentuckyApproved
KYKY_CAID_NameChangeAnnouncement.pdfAnthem Medicaid Name Change Announcement2014KentuckyApproved
KYKY_CAID_PU_MedicaidOpenEnrollment.pdfOpen Enrollment2014KentuckyApproved
KYKY_CAID_PU_ProviderCopayNotice.pdfCopays Removed from All Medical Services2014KentuckyApproved
WIWI_CAID_PU_AvailityProviderBulletin.PDFAvaility Provider Bulletin2014WisconsinApproved
WIWI_CAID_PU_PCPFaxForm_ENG.PDFPCP Change Fax Form (English)2014WisconsinApproved
WIWI_CAID_PU_PCPFaxForm_SPA.PDF PCP Change Fax Form (Spanish)2014WisconsinApproved
VAVA_CAID_Patient360Announcement.pdfPatient360 Information2015VirginiaApproved
WIWI_CAID_PU_PCPRateIncreaseDecomissioningUpdate.pdfPCP Rate Increase Decommissioning Update2015WisconsinApproved
KYKY_CAID_PU_PCPRateIncreaseDecommissioningUpdate.pdfPCP Rate Increase Decommissioning Update2015KentuckyApproved
KYKY_CAID_PU_FeeScheduleReimbursement.pdfFee Schedule Reimbursement2014KentuckyApproved
KYKY_CAID_PU_ReminderNationalCodeNumber.pdfReminder to submit NDC number and units2014KentuckyApproved
KYKY_CAID_2015AvailityFAQs.pdfAvaility FAQs2015KentuckyApproved
WIWI_CAID_PU_Dec2014ReimbPolicyBulletin.pdfDecember 2014 Reimbursement Policy Bulletin​2014WisconsinApproved
KYKY_CAID_PU_Patient360.pdfPatient3602015KentuckyApproved
KYKY_CAID_PU_UpdatedConfidentialityofRecordsPolicy.pdfUpdated Confidentiality of Records Policy2015KentuckyApproved
KYKY_CAID_PU_InpatientNewbornStays.pdfNewborn Diagnosis Related Group Policy2015KentuckyApproved
VAVA_MMP_OrthoNet_Announcement.pdfOrthoNet to Conduct Post-service Prepay Reviews2015Virginia, VA MMPApproved
KYKY_CAID_PU_PharmacyChangeNotice.pdfPharmacy Formulary Change Notice Effective March 1, 20152014KentuckyApproved
KYKY_CAID_PU_EPSDT_Referral_Codes.pdfEPSDT Referral Codes2015KentuckyApproved
KYKY_CAID_PU_CMHC_Billing_Guidance.pdfCMHC Medicaid Billing Guidance Second Edition2015KentuckyApproved
KYKY_CAID_PU_ReimbursementforProfessionalVisionServices.pdfReimbursement for Professional Vision Services2015KentuckyApproved
WIWI_CAID_PU_PregnancyNotificationBulletin.pdfNotification of Pregnancy Incentive2015WisconsinApproved
KYKY_CAID_PU_Admin_Denial_Notification.pdfKYKY_CAID_PU_Admin_Denial_Notification.pdf2014KentuckyApproved
WIWI_CAID_2015Q1_CUMGList.pdfQ1 Clinical Utilization Management Guidelines ListWisconsinApproved
KYKY_CAID_PU_ProviderRelationsRegionsMap.pdfProvider Relations Territory Map2015KentuckyApproved
KYKY_CAID_PU_FormularyChangeNotice.pdfPharmacy Formulary Change Notice Effective April 1, 2015KentuckyApproved
WIWI_CAID_2015_Q1CUMGUpdate.pdfQ1 Medical Policies and Clinical Utilization Management Guidelines Update2015WisconsinApproved
KYKY_CAID_PU_2015ReimbursementPolicyBulletin_1.pdf2015 Issue #1 Reimbursement Policy Bulletin2015KentuckyApproved
VAVA_CAID_PU_2015ReimbursementPolicyBulletin_1.pdf2015 Issue #1 Reimbursement Policy Bulletin2015VirginiaApproved
WIWI_CAID_PU_2015ReimbursementPolicyBulletin_1.pdf2015 Issue #1 Reimbursement Policy Bulletin2015WisconsinApproved
WIWI_CAID_PU_PregnancyNotificationIncentive2015.pdfNotification of Pregnancy Incentive2015WisconsinApproved
KYKY_CAID_PU_LockInProgram.pdfMember Lock-In Program2015KentuckyApproved
KYKY_CAID_PU_June2015AdvisoryNotice.pdfKentuckyApproved
WIWI_CAID_PU_OrthoNetReview.pdfCorrected information: OrthoNet medical neccessity reviews2015WisconsinApproved
WIWI_CAID_PU_SSIDenialCodes.pdfAnthem Blue Cross and Blue Shield adding SSI plan to Medicaid portfolio delayedWisconsinApproved
KYKY_CAID_PU_FormularyChangeNotice_Q22015.pdfAdvair Formulary Change Notice Effective July 1, 20152015KentuckyApproved
KYKY_CAID_PU_PTCommitteeNotice.pdfJune Pharmacy and Therapeutics Advisory Committe Meeting and Agenda2015KentuckyApproved
VAVA_CAID_PU_LARCBlastFax.pdfPostpartum long-acting contraception benefit now available2015VirginiaApproved
KYKY_CAID_PU_ICD-10_Update.pdfICD-10 Coding Update2015KentuckyApproved
VAVA_CAID_PU_ICD-10_Update.pdfICD-10 Coding Update2015VirginiaApproved
KYKY_CAID_PU_ERANotice.pdfImportant Notice to Providers registered for ERA2015KentuckyApproved
VAVA_CAID_PU_ERANotice.pdfImportant Notice to Providers who are Registered for ERA2015VirginiaApproved
WIWI_CAID_PU_ERANotice.pdfImportant Notice to Providers who are Registered for ERA2015WisconsinApproved
CACA_CAID_PU_2012BillOutpatientMedications.pdfHow to Bill Claims for Outpatient Medications9/27/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012ChildHealthDisabilityPreventionProgram.pdfChild Health and Disability Prevention Program National Standard Codes Replacing Anthem Blue Cross Proprietary Codes Physician Bulletin1/9/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012ChildHealthDisabilityPreventionProgramIPA.pdfChild Health and Disability Prevention Program National Standard Codes Replacing Anthem Blue Cross Proprietary Codes IPA Bulletin1/9/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012DrugRebateProgram.pdfMedi-Cal Drug Rebate Program Drives Changes to Claims Billing2/24/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012FutureMomsMaternityMgmt.pdfIntroducing Future Moms Maternity Management Program6/14/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012HospiceBillingGuidelines.pdfHospice Billing Guidelines5/1/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012IncentivesWellnessVisits.pdfMember Incentives for Wellness and Screening Visits11/20/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012PregnancyNotificationReportForm.pdfRevised Online and Paper Pregnancy Notification Report Form5/14/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012ReportingChangesAdmissionsClaims.pdfImportant Reporting Changes for Present on Admission Claims12/6/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012RevisedMedPolicies.pdfAnthem Blue Cross Implements New or Revised Medical Policies9/19/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012TonsillectomiesUnder18.pdfNew Guideline and Prior Authorization Requirement for Tonsillectomies on Patients Under 18 Years of Age5/31/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2012TransitionConditionCare.pdfTransition to ConditionCare5/25/2012 12:00 AM2012CaliforniaApproved
CACA_CAID_PU_2013ACAAttestationProcess.pdfAffordable Care Act (ACA) Attestation Process10/10/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013AlphaPrefixEligReports.pdfAlpha Prefix Added to Eligibility Reports Results in New Data Dictionary on ProviderAccess3/1/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013DeficienciesAudit.pdfDeficiencies Revealed in Audit Require Improvement2/1/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013FeeScheduleUpdate.pdfWe are Changing our Fee Schedules Update Process8/12/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013HealthyFamiliesTransitionMediCal.pdfHealthy Families Transition to Medi-Cal3/14/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013HIPAACompliantCodes.pdfEffective Immediately: HIPAA-Compliant Codes Required on Claims10/30/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013MCPharmacyUpdates.pdfMedi-Cal Pharmacy Updates: Where to Get Information2/28/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013NewRevisedMedicalPolicies.pdfAnthem Blue Cross Implements New or Revised Medical Policies3/1/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013NewRevisedMedPolicies.pdfAnthem Blue Cross Implements New or Revised Medical Policies7/15/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013PCPRateIncreaseReimb.pdfPCP Rate Increase Reimbursements9/17/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013PharmacyVendorsRuralCountyMC.pdfIn-Network Pharmacy Vendors for Rural County Medi-Cal Managed Care10/30/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013PriorAuthorization.pdfCommunity-Based Adult Services Prior Authorization Policy Enforced October 14, 20139/12/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013PriorAuthorizationUpdate.pdfUpdate: Prior Authorization Required on Claims8/30/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013PriorAuthorizationWaiver.pdfPrior Authorization Waiver Policy Enforced October 14, 20138/16/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013ResourceLibrary.pdfAccess the Anthem Blue Cross Resource Library for Office Improvements4/4/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013TransitionMediCalFAQ.pdfHealthy Families Transition to Medi-Cal Frequently Asked Questions4/1/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013UpdatedProviderManual.pdfUpdated and Improved Provider Manual for Anthem Blue Cross Now Available Online8/7/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013UpdateServicesRequiringPriorAuth.pdfUpdate: Change in Services Requiring Prior Authorization Effective August 1, 20134/23/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2013UsingEligibilityCapitationReports.pdfUsing Eligibility and Capitation Reports to Find Seniors and Persons with Disabilities on Your Patient Rosters2/1/2013 12:00 AM2013CaliforniaApproved
CACA_CAID_PU_2014ACAExpandsBehavioralHealthBenefits.pdfAffordable Care Act Expands Behavioral Health Benefits2/14/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014CBASAuthTreatmentPolicy.pdfCommunity-Based Adult Services (CBAS) Authorization for Treatment Policy for New Anthem Blue Cross Members2/3/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014ChangesCMSP.pdf2014 Changes to the County Medical Services Program (CMSP)2/10/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014ChangesDurableMedEquipPrecertReq.pdfUpcoming changes to durable medical equipment precertification requirements9/29/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014ClinicalUMGuidelines.pdfClinical Utilization Management Guidelines3/31/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014ClinicalUMGuidelineUpdate.pdfClinical Utilization Management Guidelines update10/13/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014ClinicalUMGuidelineUpdate2.pdfClinical Utilization Management Guideline update10/22/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014CulturalCompetencyToolkit.pdfNew Cultural Competency Toolkit Now Available1/1/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014HomeHealthNursingPriorAuthCode.pdfHome Health Nursing Services: Prior Authorization Code Update3/1/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014MedPoliciesUpdate.pdfMedical Policies update11/11/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014MonitoringPersistentMedUpdate.pdfAnnual Monitoring Persistent Medication Update8/1/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014NewPharmacyPriorAuth.pdfNew pharmacy prior authorization form – state requirement Update12/12/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014NewRevisedMedicalPolicies.pdfMedi-Cal New and Revised Medical Policies2/14/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014PharmacyVendors.pdfIn-Network Pharmacy Vendors for Anthem Medi-Cal Managed Care4/9/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014PrecertRequirementsGeneticTestCodes.pdfPrecertification requirements for genetic testing codes11/14/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014PrenatalUltrasoundCoverageCoding.pdfPrenatal Ultrasound Coverage and Coding6/11/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014PrimaryCareRateIncrease.pdfAnthem-Direct Contracted Providers and PMG/IPA Affiliated Providers3/19/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014PriorAuthInsourcing.pdfPharmacy Online Precertification Tool Update9/10/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014SleepStudyMgmtProgramHST.pdfSleep Study Management Program for In-Home Sleep Testing (HST)5/2/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014StayingHealthyAssessment.pdfUpdated Staying Healthy Assessment (SHA)3/11/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2014ValleyPresbyterianHospTerm.pdfNotification of contract termination with Valley Presbyterian Hospital9/26/2014 12:00 AM2014CaliforniaApproved
CACA_CAID_PU_2015ClinicalUMGuidelinesUpdate.pdfClinical Utilization Management Guidelines update2/23/2015 12:00 AM2015CaliforniaApproved
CACA_CAID_PU_2015DignityHealthSacramentoTermFAQ.pdfDignity Health Sacramento termination4/1/2015 12:00 AM2015CaliforniaApproved
CACA_CAID_PU_2015MedicalPoliciesUpdate.pdfMedical Policies Update: March 20153/1/2015 12:00 AM2015CaliforniaApproved
CACA_CAID_PU_2015MedPoliciesUpdate.pdfMedical Policies Update: January 20151/30/2015 12:00 AM2015CaliforniaApproved
VAVA_CAID_PU_CUMGUpdate_2015_Q2.pdfQ2 Clinical Utilization Management Guidelines Update​2015VirginiaApproved
WIWI_CAID_PU_CUMGUpdate_2015_Q2.pdfQ2 Clinical Utilization Management Guidelines Update2015WisconsinApproved
KYKY_CAID_PU_CUMGList_2015_Q2.pdfQ2 Clinical Utilization Management Guidelines List​2015KentuckyApproved
CACA_CAID_WebTour.pdfWeb tour of new Anthem Blue Cross Medicaid Provider Website5/10/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_2014ClinicalUMGuidelines.pdfClinical Utilization Management Guidelines3/31/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014ClinicalUMGuidelinesUpdate.pdfClinical Utilization Management Guidelines update10/13/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014ClinicalUMGuidelineUpdate.pdfClinical Utilization Management Guideline update10/22/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014EarlyElectiveDeliveryRP.pdfAnthem Medicaid’s Early Elective Delivery Reimbursement Policy Effective July 1, 20145/30/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014MedicalPoliciesUpdate.pdfMedical Policies update11/11/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014PrecertRequirementsGeneticTestingCodes.pdfPrecertification requirements for genetic testing codes11/14/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014ProviderReimbursementEligibility.pdfProvider reimbursement eligibility12/23/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014ReimbursementPolicyDec2014.pdfReimbursement Policy Bulletin12/29/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2014SleepStudyMgmtProgram.pdfSleep Study Management Program for in Home Sleep Testing (HST)5/22/2014 12:00 AM2014IndianaApproved
ININ_CAID_PU_2015ChangesPharmacyBenefits.pdfChanges to HIP Pharmacy Benefits and Prior Authorization2/1/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015ClinicalUMGuidelines.pdfClinical Utilization Management Guidelines3/20/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015HIPCopayments.pdfCopay Bulletin2/1/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015HIPExpansion.pdfHealthy Indiana Plan expansion2/1/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015HospitalAssessFee.pdfHospital Assessment Fee Bulletin1/29/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015MedicalPoliciesUpdate.pdfMedical policies update3/1/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015ProviderReimbursementEligibility.pdfProvider reimbursement eligibility3/31/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015SmokingCessationPregnantWomen.pdfSmoking cessation for pregnant women3/31/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015VerificationBenefitPlanWebinterChange.pdfVerification of Benefit plan using Web interchange1/29/2015 12:00 AM2015IndianaApproved
KYKY_CAID_PU_Region3Expansion.pdfKentucky Region Three Expansion2015KentuckyApproved
CACA_CAID_PU_2015DiscontinueMailingPaperRemittances.pdfPaper Remits Discontinued on October 1, 20157/15/2015 12:00 AM2015CaliforniaApproved
KYKY_CAID_PU_RPAllergyImmunotherapy.pdfAllergy Treatment: Immunotherapy Reimbursement Policy Update Effective August 1, 20152015KentuckyApproved
KYKY_CAID_PU_CMSAMAHelpICD10.pdfCMS, AMA help providers prepare for ICD-10 transition2015KentuckyApproved
VAVA_CAID_PU_ICD10Update.pdfICD-10 Update: Providers should register for ICD-10 Claims testing by September 1, 20152015VirginiaApproved
WIWI_CAID_PU_PrenatalCoverage.pdfPrenatal Ultrasound Coverage and Coding2015WisconsinApproved
CACA_CAID_PU_2015EntyvioCyramza.pdfPrecertification for Entyvio and Cyramza8/3/2015 12:00 AM2015CaliforniaApproved
CACA_MMP_PU_2015EntyvioCyramza.pdfPrecertification for Part B Drugs Entyvio and Cyramza7/15/2015 12:00 AM2015CaliforniaApproved
KYKY_CAID_PU_EntyvioandCyramza.pdfPrecertification for Entyvio and Cyramza2015KentuckyApproved
VAVA_CAID_PU_EntyvioandCyramza.pdfPrecertification for Entyvio and Cyramza2015VirginiaApproved
VAVA_MMP_PU_EntyvioandCyramza.pdfPrecertification for Part B Drugs Entyvio and Cyramza2015VirginiaApproved
WIWI_CAID_PU_HomeTherapyPrecertificationRequirements.pdfUpdate: Home Therapy Precertification Requirements Effective September 1, 20152015WisconsinApproved
KYKY_CAID_PU_HomeTherapyPrecertificationRequirements.pdfUpdate: Home therapy precertification requirements2015KentuckyApproved
CACA_CAID_PU_2015BHAuthRequirementChanges.pdfBehavioral Health Authorization Requirement Changes Effective Nov 1, 20158/20/2015 12:00 AM2015CaliforniaApproved
KYKY_CAID_PU_CervicalLengthScreeningGuidelines.pdfCervical Length Screening Guidelines2015KentuckyApproved
VAVA_CAID_PU_CervicalLengthScreeningGuidelines.pdfCervical Length Screening Guidelines2015VirginiaApproved
WIWI_CAID_PU_CervicalLengthScreeningGuidelines.pdfCervical Length Screening Guidelines2015WisconsinApproved
WIWI_CAID_PU_BehavioralHealthNovemberAuthRequirementChanges.pdfBehavioral Health: Authorization requirement changes effective November 1, 20152015WisconsinApproved
KYKY_CAID_PU_DentalCodeUpdate.pdfUpdate: Dental Screening Code D01092015KentuckyApproved
CACA_CAID_PU_2015HemophiliaDrugsMedNecessityReview.pdfHemophilia drugs medical necessity reviews - effective November 1, 20158/31/2015 12:00 AM2015CaliforniaApproved
VAVA_CAID_PU_ChangestoTranspoProvider.pdf Changes to nonemergency transportation partner2015VirginiaApproved
VAVA_MMP_ICTParticipationReimbursement.pdfPCP ICT Participation2015Virginia, VA MMPApproved
VAVA_MMP_NewPatientProcess.pdfNew Patient Payment Process2015Virginia, VA MMPApproved
VAVA_MMP_BHAuthorizationRequirementChanges.pdfBehavioral health authorization requirement changes effective October 1, 20152015VirginiaApproved
VAVA_CAID_PU_CUMGUpdate_2015Q3.pdfQ3 Clinical Utilization Management Guidelines Update​2015VirginiaApproved
WIWI_CAID_PU_CUMGUpdate_2015Q3.pdfQ3 Clinical Utilization Management Guidelines Update​2015WisconsinApproved
KYKY_CAID_PU_HemophiliaDrugsUpdate.pdfUpdate: Hemophilia drugs require medical necessity reviews effective November 1, 20152016KentuckyApproved
ININ_CAID_PU_2015EntyvioCyramza.pdfPrior authorization required for drugs Entyvio and Cyramza9/3/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015OrthoFootwearKneeBracesPriorAuth.pdfPrior authorization changes: Orthopedic footwear and custom-made knee braces6/15/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015WebTour.pdfTour our updated provider website for the latest information9/22/2015 12:00 AM2015IndianaApproved
CACA_CAID_PU_2015Q3MedPoliciesCUMGUpdate.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines Update9/22/2015 12:00 AM2015CaliforniaApproved
ININ_CAID_PU_2015Q3MedPoliciesCUMGUpdate.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines Update9/22/2015 12:00 AM2015IndianaApproved
WIWI_CAID_MedicalPoliciesCUMGUpdate_2015_Q3.pdf Q3 Medical Policies and Clinical Utilization Management Guidelines Update2015WisconsinApproved
ININ_CAID_PU_2015PresumptiveEligibilityReminder.pdfPresumptively eligible claims reminder9/23/2015 12:00 AM2015IndianaApproved
WIWI_CAID_PU_OrthonetReviews.pdfOrthoNet to conduct professional service coding reviews for musculoskeletal providers2015WisconsinApproved
WIWI_CAID_PU_AllergyTreatmentRPUpdate.pdfReimbursement Policy Update Allergy Treatment: Immunotherapy2015WisconsinApproved
VAVA_CAID_PU_AllergyTreatmentRPUpdate.pdfReimbursement Policy Update - Allergy Treatment: Immunotherapy2015VirginiaApproved
ININ_CAID_PU_2015Q3MedicalPoliciesCUMGUpdate.pdfQ3 Clinical Utilization Management Guidelines Update9/30/2015 12:00 AM2015IndianaApproved
ININ_CAID_PU_2015InpatientReadmissionsRPRevised.pdfInpatient Readmissions: Reimbursement Policy Revised10/1/2015 12:00 AM2015IndianaApproved
WIWI_CAID_PU_ProviderNewsletterUpdates.pdfProvider Newsletter Updates2015WisconsinApproved
VAVA_CAID_PU_HemophiliaDrugsUpdate.pdfHemophilia drugs authorization update effective November 15, 20152015VirginiaApproved
CACA_CAID_PU_2015ScoliosisProgram.pdfScoliosis and spinal deformity medical necessity reviews10/23/2015 12:00 AM2015CaliforniaApproved
WIWI_CAID_PU_ScoliosisandSpinalDeformityReviews.pdfScoliosis and spinal deformity medical necessity reviews2015WisconsinApproved
ININ_CAID_PU_2015CervicalLengthScreeningGuidelines.pdfCervical length screening guidelines8/20/2015 12:00 AM2015IndianaApproved
CACA_CAID_PU_2015ObstetricUltrasoundBenefitChange.pdfObstetric ultrasound benefit limitations change10/29/2015 12:00 AM2015CaliforniaApproved
CACA_MMP_PU_2015ScoliosisProgram.pdfScoliosis and spinal deformity medical necessity reviews MMP11/4/2015 12:00 AM2015CaliforniaApproved
CACA_CAID_PU_2015NewTransportationVendor.pdfNew Transportation Vendor Effective December 1, 201511/10/2015 12:00 AM2015CaliforniaApproved
KYKY_CAID_PU_PharmacyTherapeuticCommitteeDecisions.pdfKentucky Pharmacy and Therapeutics Advisory Committee Meeting Decisions - June 4, 2015 KentuckyApproved
KYKY_CAID_PU_SubmittingElectronicClaims.pdfSubmitting corrected claims electronically2015KentuckyApproved
CACA_CAID_PU_2015PharmacyFormularyChange.pdfFormulary Change Notice Effective December 1, 201512/1/2015 12:00 AM2015CaliforniaApproved
ININ_CAID_PU_2015PharmacyFormularyChangeNotice.pdfFormulary Change Notice Effective December 1, 201512/1/2015 12:00 AM2015IndianaApproved
VAVA_CAID_PU_FormularyChangeNotice_12-1-15.pdfFormulary Change Notice Effective December 1, 20152015VirginiaApproved
KYKY_CAID_PU_PharmacyandTherapeuticsMeetingAnnouncement.pdfPharmacy & Therapeutics Meeting Announcement 2015KentuckyApproved
WIWI_CAID_PU_MemberAdvocateReferralForm.pdfMember Advocate Referral Form For Providers2015WisconsinApproved
WIWI_CAID_PU_Changetoclaimsubmissions.pdfChange to inpatient claim submission requirements2015WisconsinApproved
KYKY_CAID_PU_DataManagementProgramFlier.pdfData Management Program Flier2015KentuckyApproved
KYKY_CAID_PU_SmokingCessationLeadershipCenterWebinarSeries.PDFSmoking Cessation Leadership Center webinar series2015KentuckyApproved
VAVA_MMP_PU_ChangestoBenefits.pdf2016 Summary of Benefits2016VirginiaApproved
WIWI_CAID_PU_CustomeOrthoticPrecert.pdfCustom Molded Orthotics Require Prior Authorization2016WisconsinApproved
VAVA_CAID_PU_CustomOrthoticsPrecert.pdfCustom Molded Orthotics Require Prior Authorization 15, 20152016VirginiaApproved
KYKY_CAID_PU_FormularyUpdateNotice_February2016.pdfQuarterly pharmacy formulary change notice effective February 1, 20162015KentuckyApproved
VAVA_CAID_PU_FormularyChangeNotice_February2016.pdfQuarterly pharmacy formulary change notice effective February 1, 20162015VirginiaApproved
KYKY_CAID_PU_MCGHealthCriteria.pdfMCG Health, LLC Criteria to Determine Medical Necessity2015KentuckyApproved
VAVA_CAID_PU_MPTACNotification_Q42015.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Update2015VirginiaApproved
CACA_CAID_PU_MPTACUpdate_January2016.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Update1/8/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_FormularyChangeNotice_January2016.pdfQuarterly pharmacy formulary change notice effective February 1, 20161/7/2016 12:00 AM2015IndianaApproved
WIWI_CAID_PU_RequirementsforSterilizationReimbursement.pdfRequirements for sterilization reimbursement2016WisconsinApproved
CACA_CAID_PU_2016FormularyChangeBlastFax.pdfQuarterly pharmacy formulary change notice effective February 1, 20161/13/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016PostpartumOutreachInitiative.pdfPostpartum outreach initiative1/15/2016 12:00 AM2016IndianaApproved
VAVA_CAID_PU_kneearthroscopy.pdfPrecertification for knee arthroscopy effective April, 1 20162016VirginiaApproved
VAVA_CAID_PU_PrecertificationforKneeandHipArthroplasty.pdfPrecertification for knee and hip arthroplasty effective May 1, 20162016VirginiaApproved
WIWI_CAID_PU_PrecertificationforKneeandHipArthroplasty.pdfPrecertification for knee and hip arthroplasty effective May 1, 20162016WisconsinApproved
WIWI_CAID_PU_Precertforkneearthroscopy.pdfPrecertification for knee arthroscopy effective April 1, 20162016WisconsinApproved
KYKY_CAID_PU_Precertforkneeandhiparthroplasty.pdfPrecertification for knee and hip arthroplasty effective May 1, 20162016KentuckyApproved
KYKY_CAID_PU_PharmacyTherapeuticCommitteeDecisions_Dec2015.pdfKentucky Pharmacy and Therapeutics Advisory Committee Meeting Decisions - December 16, 20152016KentuckyApproved
KYKY_CAID_PU_Precertforkneearthroscopy.pdfPrecertification for knee arthroscopy effective April 1, 20162016KentuckyApproved
VAVA_CAID_PU_RadiationTherapy.pdfRadiation Therapy: Select Brachytherapy, IMRT CPT codes require prior authorization effective May 1, 20162016VirginiaApproved
CACA_CAID_PU_2016HospitalTermBulletin.pdfHospital Termination Provider Bulletin- West Hills and Riverside Hospitals2/7/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016KneeArthroscopy.pdfPrecertification for knee arthroscopy effective April 1, 20162/4/2016 12:00 AM2016IndianaApproved
ININ_CAID_PU_2016KneeHipArthroscopy.pdfPrecertification for knee and hip arthroplasty effective May 1, 20162/4/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_17PLetter.pdfImportant information regarding 17P coverage2016KentuckyApproved
ININ_CAID_PU_2016CustomMoldedOrthotics.pdfCustom molded orthotics require prior authorization4/28/2016 12:00 AM2016IndianaApproved
WIWI_CAID_PU_Changestoclaimssubmissionsoutpatient.pdfChanges to claims submission requirements for outpatient hospital services2016WisconsinApproved
VAVA_MMP_PU_ReimbursementforICTParticipation.pdfNew for PCP – reimbursement for interdisciplinary care team (ICT) participation2016Virginia, VA MMPApproved
VAVA_MMP_PU_PrecertUpdatesNursingFacility.pdfPrecertification changes for custodial nursing facility care2016Virginia, VA MMPApproved
ININ_CAID_PU_2016MedPoliciesUMGuidelinesUpdate.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Update 3/4/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_RequestTaxonomyCodeUpdate.pdfRequest for to update taxonomy code2016KentuckyApproved
CACA_CAID_PU_2016QuarterlyPharmacyFormularyChange.pdfQuarterly pharmacy formulary change3/24/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016MedPoliciesUMGuidelinesUpdate2.pdfMedical policies and Clinical Utilization Management Guidelines update 3/30/2016 12:00 AM2016IndianaApproved
WIWI_CAID_PU_PrenatalUltrasoundICD10Update.pdfPrenatal Ultrasound Policy/ICD-10 Update2016WisconsinApproved
KYKY_CAID_PU_PrenatalUltrasoundICD10Update.pdfPrenatal Ultrasound Policy/ICD-10 Update2016KentuckyApproved
ININ_CAID_PU_2016QuarterlyPharmacyFormularyChange.pdfProvider update: Quarterly pharmacy formulary change notice4/1/2016 12:00 AM2016IndianaApproved
VAVA_CAID_PU_UltrasoundICD10Update.pdfPrenatal Ultrasound Policy/ICD-10 Update2016VirginiaApproved
VAVA_MMP_PU_AdditionalRadiationOncologyPAs.pdfAdditional Radiation Oncology PAs Directed to AIM2016Virginia, VA MMPApproved
KYKY_CAID_PU_LesserofApplication.pdfLesser of Application2016KentuckyApproved
KYKY_CAID_PU_UpdatetoAttendingProviderBillingRequests.pdfUpdate to Attending Provider Billing Requests 2016KentuckyApproved
CACA_CAID_PU_2016Q1MPTACUpdate.pdfMedical policies and Clinical Utilization Management Guidelines update 4/11/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016Q1MPTACUpdate.pdfMedical policies and Clinical Utilization Management Guidelines update4/11/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_QuarterlyFormularyUpdate_May12016.pdfQuarterly pharmacy formulary change notice effective May 1, 20162016KentuckyApproved
WIWI_CAID_PU_2016_MedicalPoliciesandCUMGUpdate.pdfMedical policies and Clinical Utilization Management Guidelines update2016WisconsinApproved
VAVA_CAID_PU_2016_CoverageGuidelinesandCUMGUpdate.pdfCoverage guidelines and Clinical Utilization Management Guidelines update2016VirginiaApproved
CACA_CAID_PU_2016CertainDrugsMedicalNecessityReviews.pdfCertain drugs medical necessity reviews4/14/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016DrugsAddedPA.pdfEffective June 15, 2016: Drugs added to prior authorization4/18/2016 12:00 AM2016IndianaApproved
WIWI_CAID_PU_HealthyRewardsFlier.pdfHealthy Rewards Program August Update Flier2016WisconsinApproved
VAVA_CAID_PU_HealthyRewardsFlier.pdfHealthy Rewards Flier2018VirginiaApproved
CACA_CAID_PU_2016PharmacyPriorAuthIssueResolution.pdfUpdate on Pharmacy Prior Authorization Submissions4/1/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_ESIOutageUpdate.pdfUpdate on Pharmacy Prior Authorization Submissions2016VirginiaApproved
ININ_CAID_PU_2016ScoliosisSpinalDeformity.pdfPrior Authorization Requirements For Scoliosis And Spinal Deformity Services4/27/2016 12:00 AM2016IndianaApproved
ININ_CAID_PU_2016PrenatalUltrasoundICD10Update.pdfPrenatal Ultrasound Policy/ICD-10 Update 5/5/2016 12:00 AM2016IndianaApproved
CACA_CAID_PU_2016KneeSpinalOrthosesPrecertUpdate.pdfPrecertification for knee and spine orthoses effective July 1, 20165/6/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_Precertforkneeandspineorthoses.pdfPrecertification for knee and spine orthoses effective July 1, 2016 2016VirginiaApproved
WIWI_CAID_PU_Precertforkneeandspineorthoses.pdfPrecertification for knee and spine orthoses effective July 1, 2016 2016WisconsinApproved
ININ_CAID_PU_2016KneeSpinalOrthosesPrecertUpdate.pdfPrecertification for knee and spine orthoses effective July 1, 20165/10/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_ReductioninReimbursementtoNonParProviders.pdfReduction in reimbursement to nonparticipating providers2016KentuckyApproved
KYKY_CAID_PU_SanctionedProviderEdits.pdfSanctioned Provider Edits2016KentuckyApproved
CACA_CAID_PU_DiabeticChange.pdfDiscontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies5/1/2016 12:00 AM2016CaliforniaApproved
KYKY_CAID_PU_DiabeticChange.pdfDiscontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies2016KentuckyApproved
VAVA_CAID_PU_DiabeticChange.pdfDiscontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies2016VirginiaApproved
ININ_CAID_PU_OnlinePeerSupportforHCCMembers.pdfOnline Peer Support for Hoosier Care Connect Member6/10/2016 12:00 AM2016IndianaApproved
WIWI_CAID_PU_DMEModifiers.pdfDME Modifiers for New and Rented Equipment2016WisconsinApproved
WIWI_CAID_PU_PrecertUpdateVascularembolization.pdfPrecertification update for vascular embolization or occlusion services2016WisconsinApproved
VAVA_CAID_PU_QuarterlyFormularyChange_June2016.pdfQuarterly pharmacy formulary change notice effective July 1, 20162016VirginiaApproved
KYKY_CAID_PU_LARCBenefitLetter.pdfNew LARC benefit provider letter2016KentuckyApproved
KYKY_CAID_PU_FormularyChangeNotice_July2016.pdfQuarterly pharmacy formulary change notice effective July 1, 20162016KentuckyApproved
CACA_CAID_PU_2016QuarterlyPharmacyFormularyChange2.pdfQuarterly pharmacy formulary change notice effective July 1, 20166/27/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016QuarterlyPharmacyFormularyChange2.pdfQuarterly pharmacy formulary change notice effective July 1, 20166/27/2016 12:00 AM2016IndianaApproved
CACA_CAID_PU_VascularEmbolizationOcclusionServices.pdfPrecertification update for vascular embolization or occlusion services7/1/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_PrecertUpdateVascularEmbolization.pdfPrecertification update for vascular embolization or occlusion services2016VirginiaApproved
KYKY_CAID_PU_NulojixPriorAuth.pdfPrior authorization requirement for Nulojix effective August 5, 20162016KentuckyApproved
KYKY_CAID_PU_VaccinesforChildrenBillingGuidance.pdfVaccines for Children Program billing guidelines2016KentuckyApproved
CACA_MMP_PU_2016UpdateKneeSpinalOrthosesPrecertUpdate.pdfUpdate on precertification requirements for knee and spinal orthoses7/1/2016 12:00 AM2016CaliforniaApproved
VAVA_MMP_PriorAuthSpinalKnee.pdfUpdate on precertification requirements for knee and spinal orthoses2016VirginiaApproved
CACA_MMP_PU_2016VascularEmbolizationOcclusionServices.pdfMMP Precertification update for vascular embolization or occlusion services7/11/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016VascularEmbolizationOcclusionPriorAuth.pdfPrecertification update for vascular embolization or occlusion services7/11/2016 12:00 AM2016IndianaApproved
ININ_CAID_PU_2016QuarterlyPharmacyFormularyChange3.pdfQuarterly pharmacy formulary change notice effective September 1, 20167/25/2016 12:00 AM2016IndianaApproved
CACA_CAID_PU_2016QuarterlyPharmacyFormularyChange3.pdfQuarterly pharmacy formulary change notice effective September 1, 20167/25/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_QuarterlyPharmacyChangeNotice_July2016.pdfQuarterly pharmacy formulary change notice effective September 1, 20162016VirginiaApproved
VAVA_MMP_PU_PriorAuthSpinalKnee.pdfUpdate on precertification requirements for knee and spinal orthoses2016Virginia, VA MMPApproved
KYKY_CAID_PU_UpdateTaxonomyCode.pdfUpdate Taxonomy Code2016KentuckyApproved
KYKY_CAID_PU_MCGGuidelines.pdf20th Edition of MCG to determine medical necessity2016KentuckyApproved
VAVA_CAID_PU_NondiscriminationAccessibilityUpdate.pdfFederal nondiscrimination and accessibility update.2016VirginiaApproved
WIWI_CAID_PU_FederalNondiscrimandAccessibilityUpdate.pdfFederal nondiscrimination and accessibility update2016WisconsinApproved
KYKY_CAID_PU_MedicaidPhysicianFeeSchedule.pdfMedicaid physician fee schedule: place of service codes and pricing2016KentuckyApproved
CACA_CAID_PU_2016NondiscriminationAccessibilityUpdate.pdfFederal nondiscrimination and accessibility update8/10/2016 12:00 AM2016CaliforniaApproved
KYKY_CAID_PU_FederalNDAccessibilityRequirementsUpdate.pdfFederal nondiscrimination and accessibility update2016KentuckyApproved
KYKY_CAID_PU_ZikaVirusWarning.pdfPublic Health Officials Zika Virus Warning2016KentuckyApproved
KYKY_CAID_PU_SanctionedProviderUpdate.pdfUpdate to Sanctioned Provider Edit2016KentuckyApproved
KYKY_CAID_ProviderSurvey.pdf2016 Provider Satisfaction Survey Reminder2016KentuckyApproved
KYKY_CAID_PU_CoordinationofBenefits.pdfCoordination of benefits — policy update2016KentuckyApproved
KYKY_CAID_PU_FormularyChange.pdfQuarterly pharmacy formulary change notice effective October 1, 20162016KentuckyApproved
CACA_MMP_PU_2016InjectableInfusableDrugs.pdfMMP New Injectable Infusible Drugs Istodax, Ixempre and Taltz 9/1/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_FormularyChangeNotice.pdfICS Quarterly pharmacy formulary change notice effective September 1, 20162016VirginiaApproved
WIWI_CAID_2016MPCUMGUpdateQ2.pdfQ2 Medical policies and Clinical Utilization Management (UM) Guidelines (8/31/16)2016WisconsinApproved
VAVA_CAID_2016MPCUMGUpdateQ2.pdfQ2 Medical policies and Clinical Utilization Management (UM) Guidelines (8/31/16)2016VirginiaApproved
CACA_CAID_PU_2016MedicalPoliciesNotificationQ2.pdfQ2 Medical policies and Clinical Utilization Management (UM) Guidelines8/31/2016 12:00 AM2016CaliforniaApproved
KYKY_CAID_ProviderRelationContactInfo.pdfProvider Relations contact information2016KentuckyApproved
VAVA_CAID_PU_QuarterlyFormularyChange_September2016.pdfQuarterly pharmacy formulary change notice effective September 1, 20162016VirginiaApproved
CACA_CAID_PU_QuarterlyFormularyChange_September2016.pdfQuarterly pharmacy formulary change notice effective September 1, 20169/1/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_QVARFormularyChangeSept2016.pdfQVAR pharmacy formulary change notice effective September 1, 20162016VirginiaApproved
ININ_CAID_PU_2016QuarterlyPharmacyFormularyChange4.pdfQVAR pharmacy formulary change notice effective September 1, 20169/23/2016 12:00 AM2016IndianaApproved
KYKY_CAID_QVARFormularyChangeSept2016.pdfQVAR pharmacy formulary change notice effective September 1, 20162016KentuckyApproved
CACA_PU_QuarterlyFormularyChangeSept2016.pdfQVAR pharmacy formulary change notice effective September 1, 20169/23/2016 12:00 AM2016CaliforniaApproved
VAVA_MMP_NewInjectableDrugs.pdfNew Injectable Infusible Drugs - Emend (fosaprepitant), Aloxi (palonosetron) and Afstyla (antihemophilic)2016VirginiaApproved
CACA_MMP_PU_2016NewInjectableDrugs.pdfNew Injectable Infusible Drugs - Emend (fosaprepitant), Aloxi (palonosetron) and Afstyla (antihemophilic)10/1/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_2016Q2CUMG.pdf Q2 Medical policies and Clinical Utilization Management (UM) Guidelines9/28/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_QuarterlyFormularyUpdate_Sept2016.pdfQuarterly pharmacy formulary change notice effective September 1, 20162016KentuckyApproved
VAVA_CAID_PU_ZikaInformationPacket.pdfZika Virus Information Packet 2016VirginiaApproved
ININ_CAID_PU_2016QuarterlyPharmacyFormularyChange5.pdfQuarterly pharmacy formulary change notice effective November 1, 201610/20/2016 12:00 AM2016IndianaApproved
CACA_CAID_PU_2Q16FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective November 1, 201610/21/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChange.pdfQuarterly pharmacy formulary change notice effective November 1, 20162016VirginiaApproved
KYKY_CAID_PU_QuarterlyFormularyUpdate_Nov2016.pdfQuarterly pharmacy formulary change notice effective November 1, 20162016KentuckyApproved
CACA_MMP_PU_2016DoxilandSustol.pdfMMP New Injectable/Infusible Drugs Doxil and Sustol - Effective January 1, 201711/2/2016 12:00 AM2016CaliforniaApproved
CACA_MMP_PU_2016PriorAuthChangeInterferonMecaserminAzacitidine.pdfMMP Prior Authorization Change to Drugs Interferon, Mecasermin and Azacitidine - Effective February 1, 201711/2/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_IBOutlierNotice.pdfChange to inpatient diagnosis-related group claim submissions2016VirginiaApproved
KYKY_CAID_PU_DRGUpdate.pdfDiagnosis Related Group version update2016KentuckyApproved
KYKY_CAID_PU_Changestoapprovalnotificationprocess.pdfChanges to approval notification process2016KentuckyApproved
VAVA_MMP_PU_PAElotuzmabInjectable.pdfPrior authorization requirements for new injectable/infusible drugs: Darzalex (daratumumab) and Empliciti (elotuzumab)2016VirginiaApproved
VAVA_CAID_PU_HomeHealthAuthandBillingRequirements.pdfHealthKeepers, Inc. home health authorization and billing requirements - Effective November 1, 20162016VirginiaApproved
WIWI_CAID_PU_ImplementationofAPRDRGPricing.pdfImplementation of APR DRG Pricing2016WisconsinApproved
CACA_CAID_PU_2016PriorAuthDarzalexEmpliciti.pdfPrior authorization requirements for new injectable/infusible drugs: Darzalex (daratumumab) and Empliciti (elotuzumab)11/9/2016 12:00 AM2016CaliforniaApproved
KYKY_CAID_PU_PharmacyandTheraeuticsAdvisoryMtg_Dec2016.pdfPharmacy and Therapeutics Advisory Committee Meeting - December 7, 2016 KentuckyApproved
VAVA_CAID_PU_CUMGUpdatev2_Q32016.pdfCoverage Guidelines and Clinical Utilization Management Guidelines update2016VirginiaApproved
WIWI_CAID_PU_CUMGUpdatev2_q32016.pdfMedical Policies and Clinical Utilization Management Guidelines update2016WisconsinApproved
ININ_CAID_PU_2016Q3CUMG.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines update 11/22/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_ChangesToChiropracticServices.pdfChanges to Chiropractic Services2016KentuckyApproved
KYKY_CAID_PU_AuthRequirementChangesforBehavioralHealth.pdfAuthorization requirement changes for behavioral health2016KentuckyApproved
CACA_MMP_PU_2016PriorAuthNewInjectableDrugs.pdfMMP New Injectable Infusible Drugs: Erelzi (etanercept), Amjevita (adalimumab), Voretigene neparvovec, Nanacog (recombinant factor IX) and Lartruvo (olaratumab)12/8/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016More2017Changes.pdfMore changes on the way for 201712/9/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_ProcessChangeforNPITaxonomyCode.pdfProcess change for adding or updating the NPI/taxonomy code2016KentuckyApproved
CACA_CAID_PU_2016Q3MPTACUpdate.pdfMedical Policies and Clinical Utilization Management Guidelines update 12/16/2016 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChange_Feb2017.pdfQuarterly pharmacy formulary change notice effective February 1, 20172016VirginiaApproved
CACA_CAID_PU_2016FormularyChangeBlastFax2.pdfQuarterly pharmacy formulary change notice effective February 1, 201712/19/2016 12:00 AM2016CaliforniaApproved
CACA_MMP_PU_2016PriorAuthTorisel.pdfMMP PA Drugs Torisel12/15/2016 12:00 AM2016CaliforniaApproved
CACA_CAID_PU_2016PriorAuthIstodaxIxempraDoxiToriseInflectra.pdfIstodax_Ixempra _Doxil_Torisel_Inflectra12/15/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016PriorAuthIstodaIxempraDoxiToriseInflectra.pdfIstodax, Ixempra, Doxil, Torisel, Inflectra12/15/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_ImportanceofBHCollaboration.pdfImportance of Behavioral Health Collaboration2016KentuckyApproved
KYKY_CAID_PU_SBIRT.pdfSBIRT2016KentuckyApproved
KYKY_CAID_PU_ReimbursementLimitforCPTCodes.pdfReimbursement Limitation for CPT Codes 99214 and 992152016KentuckyApproved
KYKY_CAID_PU_FormularyChangeNotice_Feb12017.pdfQuarterly pharmacy formulary change notice effective February 1, 20172017KentuckyApproved
ININ_CAID_PU_2017UpdatesProviderAttachments.pdf2017 updates to provider attachments1/27/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017QuarterlyPharmacyFormularyChange.pdfQuarterly pharmacy formulary change notice effective February 1, 20171/5/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_PharmacyTherapeuticCommitteeDecisions_Dec2016.pdfPharmacy and Therapeutics Committee Meeting Minutes - December 7, 20162017KentuckyApproved
KYKY_CAID_PU_E59Denials.pdfE59 denials — attending taxonomy missing/invalid2016KentuckyApproved
VAVA_CAID_PU_IsotaxIxempraDoxilToriselInflectra.pdfIstodax, Ixempra, Doxil, Torisel, Inflectra2016VirginiaApproved
KYKY_CAID_PU_PhysicianFeeSchedulePOSMapping.pdfPhysician Fee Schedule - POS Mapping2017KentuckyApproved
KYKY_CAID_PU_NewTelehealthPlaceOfServiceCodes.pdfNew place of service code for telehealth2017KentuckyApproved
CACA_MMP_PU_2017CuvitruOcrevusLutathera.pdfMMP Prior authorization change for new injectable/infusible drugs: Cuvitru, Ocrevus and Lutathera - effective March 1, 20171/18/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_QuarterlyFormularyUpdate_Jan2017.pdfQuarterly pharmacy formulary change notice effective March 1, 20172017KentuckyApproved
WIWI_CAID_QualifiedTreatmentTrainees.pdfQualified treatment trainees2017WisconsinApproved
CACA_MMP_PU_2017HospitalObservationServiceLimits.pdfMMP Hospital observation service limits1/25/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_2017HospitalPresumptiveEligibilityGuide.pdfHospital presumptive eligibility reference guide1/30/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChange_March2017.pdfQuarterly pharmacy formulary change notice effective March 1, 20172017VirginiaApproved
WIWI_CAID_PU_PARequiredforCABG.pdfPA required for Coronary Artery Bypass Graft (attachment reads CABG)2017WisconsinApproved
WIWI_CAID_PU_PARequiredforIstodaxIxempraDoxilToriselInflectra.pdfPA required for Istodax, Ixempra, Doxil, Torisel and Inflectra2017WisconsinApproved
KYKY_CAID_PU_BHTreatmentPlanReminder.pdfBH Treatment Plan Reminder2017KentuckyApproved
CACA_CAID_PU_2017QuarterlyPharmacyFormularyChange.pdfQuarterly pharmacy formulary change notice effective March 1, 20172/1/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_ChiropracticServicesUpdate.pdfChiropractic Services Update2017KentuckyApproved
CACA_CAID_PU_2016AttendingNPI.pdfMedicaid claims must have individual attending provider NPI12/14/2016 12:00 AM2016CaliforniaApproved
CACA_CAID_PU_2016PriorAuthCoronaryArteryBypassGraft.pdfPA for Coronary Artery Bypass Graft12/14/2016 12:00 AM2016CaliforniaApproved
CACA_MMP_PU_2016PriorAuthCoronaryArteryBypassGraft.pdfMMP PA for Coronary Artery Bypass Graft12/14/2016 12:00 AM2016CaliforniaApproved
CACA_MMP_PU_2016PriorAuthDoxilSustol.pdfMMP PA for Doxil, Susutol12/14/2016 12:00 AM2016CaliforniaApproved
CACA_MMP_PU_2016PriorAuthInflectraCinqair.pdfMMP Change to Infusible Drugs Inflectra, Cinqair12/14/2016 12:00 AM2016CaliforniaApproved
ININ_CAID_PU_2016PriorAuthCoronaryArteryBypassGraft.pdfPA required for Coronary Artery Bypass Graft12/15/2016 12:00 AM2016IndianaApproved
KYKY_CAID_PU_ImportanceofBHCollaborationBrochure.pdfImportance of Behavioral Health Collaboration Brochure2017KentuckyApproved
ININ_CAID_PU_2017Q4MPCUMGUpdate.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Update2/8/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_2016Q4MPCUMGUpdate.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines update2/6/2017 12:00 AM2016CaliforniaApproved
VAVA_CAID_PU_CUMGUpdate_2016_Q4.pdfQ4 Coverage Guidelines and Clinical Utilization Management Guidelines update2016VirginiaApproved
WIWI_CAID_PU_CUMGUpdate_Q42016.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines update2016WisconsinApproved
KYKY_PharmacyTherapeuticCommitteeAgenda_Feb2017.pdfPharmacy and Therapeutics Advisory Committee Meeting - February 28, 20172017KentuckyApproved
ININ_CAID_PU_2017BHOutpatientPriorAuthFax.pdfBehavioral health outpatient prior authorization fax2/14/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017ClaimsXten.pdfAdditional information on ClaimCheck® upgrade to ClaimsXten™2/17/2017 12:00 AM2017IndianaApproved
CACA_MMP_PU_2017PriorAuthEvomela.pdfMMP Part B Drug Evomela11/6/2017 12:00 AM2017CaliforniaApproved
WIWI_CAID_PU_ClaimCheckupgradetoXten.pdfAdditional information on ClaimCheck® upgrade to ClaimsXten™2017WisconsinApproved
VAVA_CAID_PU_ClaimCheckUpgradetoClaimsXten.pdfAdditional information on ClaimCheck® upgrade to ClaimsXten™2017VirginiaApproved
KYKY_CAID_PU_ClaimCheckUpgradetoClaimsXten.pdfAdditional information on ClaimCheck® upgrade to ClaimsXten™2017KentuckyApproved
VAVA_CAID_PA_CABG.pdfPA required for elective Coronary Artery Bypass Graft 2016VirginiaApproved
ININ_CAID_PU_2017AIMSpecialityHealthExpansion.pdfAIM Specialty Health Expansion Bulletin - Revised2/20/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017ERAutoPayList.pdfChanges to the ER Auto-Pay List2/20/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_LeadTesting.pdfScreen for Lead: Every Child, Every Time2017VirginiaApproved
KYKY_CAID_PU_AuthorizationRuleAdditionsandDeletionsEffective4-17.pdfAuthorization rule additions and deletions effective April 1, 20172017KentuckyApproved
KYKY_CAID_PU_InterqualGuidelines.pdfInterqual guidelines to determine medical necessity2017KentuckyApproved
WIWI_CAID_PU_PARequiredforContinuousInterstitialGlucoseMonitoring.pdfPA required for Continuous Interstitial Glucose Monitoring2017WisconsinApproved
CACA_MMP_PU_2017ClaimsXtenUpgrade.pdfMMP Additional information on ClaimCheck upgrade to ClaimsXten3/3/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_FacilityClinicChargeRP.pdfFacility clinic charge reimbursement policy2017KentuckyApproved
VAVA_CAID_PU_PrenatalUltrasoundMod52.pdfAdding modifier 52 to the routine anatomic evaluation billing code2017VirginiaApproved
WIWI_CAID_PU_PrenatalUltrasoundMod52.pdfAdding modifier 52 to the routine anatomic evaluation billing code2017WisconsinApproved
KYKY_CAID_PU_AddingModifier52.pdfAdding modifier 52 to the routine anatomic evaluation billing code2017KentuckyApproved
KYKY_CAID_EXPRESSClaimEditsInvitation.pdfIMPORTANT Claims Edits for ORPA Providers2017KentuckyApproved
ININ_CAID_PU_2017QuarterlyPharmacyFormularyChange2.pdfQuarterly pharmacy formulary change notice effective March 1, 20173/10/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_2017QuarterlyPharmacyFormularyChange2.pdfQuarterly pharmacy formulary change notice effective May 1, 20173/15/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_FormularyChangeNotice_May12017.pdfQuarterly pharmacy formulary change notice effective May 1, 20172017KentuckyApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChange_May12017.pdfQuarterly pharmacy formulary change notice effective May 1, 20172017VirginiaApproved
VAVA_CAID_PU_AmendementtoProviderAgreement.pdfAmendment to Provider Agreement2017VirginiaApproved
KYKY_CAID_PU_FacilityChangeBulletin.pdfFacility Clinic Charge Bulletin2017KentuckyApproved
KYKY_CAID_PU_MedicalPolicyUpdateNotification_2017.pdfMedical Policy Update Notification2017KentuckyApproved
WIWI_CAID_PU_PADrugsusedintheoutpatienthospitalsetting.pdfPrior authorization of drugs used in the outpatient hospital setting2017WisconsinApproved
KYKY_CAID_PU_ProviderAppeals_MedicalNecessityandPayment.pdfProvider Appeals - Medical Necessity and Payment2017KentuckyApproved
ININ_CAID_PU_2017PrenatalUltrasoundMod52.pdfIN Prenatal Ultrasound (PNU) Modifier-524/20/2017 12:00 AM2017IndianaApproved
KYKY_PharmacyTherapeuticCommitteeMinutes_Feb2017.pdfPharmacy and Therapeutics Committee Meeting Minutes - February 28, 20172017KentuckyApproved
KYKY_CAID_PU_AuthorizationRuleAdditionsEffective5-17.pdfAuthorization rule additions effective May 1, 20172017KentuckyApproved
WIWI_CAID_PU_GeneticTestingServices.pdfGenetic testing services to require prior authorization2017WisconsinApproved
ININ_CAID_PU_2017QuarterlyPharmacyFormularyChange3.pdfQuarterly pharmacy formulary change notice effective May 1, 20174/14/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_GeneticTestingServicesPriorAuth.pdfGenetic Testing Services Prior Authorization2017VirginiaApproved
CACA_MMP_PU_2017Patient360onAvaility.pdfMMP Beginning in April: Access Patient360 directly through the Availity Web Portal4/19/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_2017GeneticTestingServices.pdfGenetic Testing Services Prior Authorization6/15/2017 12:00 AM2017IndianaApproved
CACA_MMP_PU_2017ContinuousInterstitialGlucoseMonitoring.pdfMMP Prior authorization required for continuous interstitial glucose monitoring5/1/2017 12:00 AM2017CaliforniaApproved
VAVA_CAID_PU_Patient360AccessViaAvaility.pdfBeginning in April: Access Patient360 directly through the Availity Web Portal2017VirginiaApproved
CACA_CAID_PU_2017Patient360Availity.pdfBeginning in April: Access Patient360 directly through the Availity Web Portal5/4/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_EXPRESSClaimEditsBulletin.pdfOrdering, Referring, Prescribing and Attending Providers Webinar2017KentuckyApproved
WIWI_CAID_PU_Patient360AvailityAccess.pdfBeginning in April: Access Patient360 directly through the Availity Web Portal2017WisconsinApproved
KYKY_CAID_PU_ClaimDenialz21.pdfClaim denial — Z21 provider type2017KentuckyApproved
ININ_CAID_PU_2017MemberIdentificationNumbers.pdfMember identification numbers5/10/2017 12:00 AM2017IndianaApproved
CACA_MMP_PU_2017InpatientReadmissionsUpdate.pdfInpatient Readmissions Update (MMP)5/10/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_2017PriorAuthPolicies.pdfPolicies for Prior Authorizations5/11/2017 12:00 AM2017IndianaApproved
WIWI_CAID_PU_HomeVentilatorClaims.pdfHome Ventilator Claims2017WisconsinApproved
ININ_CAID_PU_2017Patient360Availity.pdfBeginning in April: Access Patient360 directly through the Availity Web Portal5/15/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017QuarterlyPharmacyFormularyChange4.pdfQuarterly pharmacy formulary change notice effective June 15, 20175/15/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_UpdatetoClaimsCheckupgrade.pdfUpdate to the ClaimsCheck® upgrade to ClaimsXten™2017VirginiaApproved
KYKY_CAID_PU_PandTCommitteeMeetingMinutes_April2017.pdfPharmacy and Therapeutics Committee Meeting Minutes - April 26, 2017KentuckyApproved
CACA_MMP_PU_2017ClaimsXtenUpgrade2.pdfMMP Update to the ClaimsCheck® upgrade to ClaimsXten™5/15/2017 12:00 AM2017CaliforniaApproved
VAVA_CAID_PU_InpatientReadmissionsUpdate.pdfInpatient Readmissions Update 2017VirginiaApproved
KYKY_CAID_PU_ClaimsCheckArticle.pdfUpdate to the ClaimsCheck® upgrade to ClaimsXten™2017KentuckyApproved
WIWI_CAID_PU_ClaimsCheckArticle.pdfUpdate to the ClaimsCheck® upgrade to ClaimsXten™2017WisconsinApproved
KYKY_CAID_FQHCClaimsEncounters.pdfFederally qualified health center claims encounters2017KentuckyApproved
CACA_CAID_PU_2017ProviderPreventableConditionsReporting.pdfNotification of Provider Preventable Conditions Reporting6/7/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_QuarterlyPharmacyChangeNotice_May26_2017.pdfQuarterly pharmacy formulary change notice effective May 26, 20172017KentuckyApproved
CACA_MMP_PU_2017PriorAuthPartBSpinraza.pdfMMP Prior authorization requirements for Part B drug: Spinraza (nusinersen)5/30/2017 12:00 AM2017CaliforniaApproved
CACA_MMP_PU_2017PriorAuthPartBBavencio.pdfMMP Prior authorization requirements for Part B drug: Bavencio (avelumab) 5/30/2017 12:00 AM2017CaliforniaApproved
CACA_MMP_PU_2017PriorAuthPartBHerceptin.pdfMMP Prior authorization requirements for Part B drug: Herceptin (trastuzumab) 5/30/2017 12:00 AM2017CaliforniaApproved
WIWI_CAID_PU_PeerToPeerThirdPartyReviews.pdfPeer to Peer Third Party 2017WisconsinApproved
WIWI_CAID_PU_LicensedMidwivesBulletin.pdfLicensed Midwives Bulletin2017WisconsinApproved
WIWI_CAID_PU_CUMGUpdate_Q12017.pdfQ1 Medical Policies and Clinical Utilization Management Guidelines update2017WisconsinApproved
KYKY_CAID_PU_AlliantHealthSolutionsCollaboration.pdfAlliant Health Solutions collaboration2017KentuckyApproved
CACA_MMP_PU_ModifierFXandRPUpdate.pdfModifier FX and Reimbursement Policy Update (MMP)6/7/2017 12:00 AM2017CaliforniaApproved
VAVA_MMP_PU_ModifierFXandRPUpdate.pdfModifier FX and Reimbursement Policy Update (MMP)2017VirginiaApproved
WIWI_CAID_PU_AIMInitiativeAnnouncement.pdfAIM Initiative Announcement2017WisconsinApproved
WIWI_CAID_PU_Wheelchaircomponentoraccessory.pdfWheelchair component or accessory, not otherwise specified to require prior authorization2017WisconsinApproved
VAVA_CAID_PU_WheelchairComponentorAccessory.pdfWheelchair component or accessory, not otherwise specified to require prior authorization2017VirginiaApproved
CACA_CAID_PU_2017WheelchairComponent.pdfWheelchair component or accessory, not otherwise specified to require prior authorization6/8/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_SportsPhysicalFlier.pdfMember Value-Added Benefit: Free Sports Physicals2017KentuckyApproved
CACA_CAID_PU_2015UpdatedEncounterStandards.pdfUpdated Encounter Standards6/5/2015 12:00 AM2015CaliforniaApproved
WIWI_CAID_PU_2016CAHPSducation.pdf2016 CAHPS Education2017WisconsinApproved
ININ_CAID_PU_2017BillingAppropriateNPITaxonomy.pdfBilling Appropriate NPI and Taxonomy6/16/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_2017QuarterlyPharmacyFormularyChange3.pdfQuarterly pharmacy formulary change notice effective August 1, 20176/21/2017 12:00 AM2017CaliforniaApproved
CACA_CAID_PU_2017MediCalInNetworkPharmacyVendors.pdfIn-network pharmacy vendors for Medi-Cal Managed Care (Medi-Cal)6/26/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_Patient360NewsletterArticle.pdfBeginning in April: Access Patient360 directly through the Availity Web Portal2017KentuckyApproved
KYKY_CAID_PU_FormularyChangeBlastFax.pdfQuarterly pharmacy formulary change notice effective August 1, 20172017KentuckyApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChange_August2017.pdf Quarterly pharmacy formulary change notice effective August 1, 20172017VirginiaApproved
KYKY_CAID_PU_WhatisHEDIS2017.pdfWhat does HEDIS mean to you?2017KentuckyApproved
KYKY_CAID_PU_AlliantHealthSolutionsPartnership.pdfAlliant Health Solutions Partnership2017KentuckyApproved
ININ_CAID_PU_2017QuarterlyPharmacyFormularyChange5.pdfQuarterly pharmacy formulary change notice effective August 1, 20176/29/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_Q1MPTACNotification2017.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines7/3/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_Q1MPTACNotification2017.pdfQ1 Coverage Guidelines and Clinical Utilization Management Guidelines update2017VirginiaApproved
VAVA_CAID_PU_HospiceAmendment_8-1.pdfHospice amendment effective August 1, 20172017VirginiaApproved
VAVA_CAID_PU_Earlyinterventionservicesamendment.pdfEarly intervention services amendment effective August 1, 20172017VirginiaApproved
WIWI_CAID_PU_HemophiliaFactor.pdfHemophilia factor injections to require prior authorization2017WisconsinApproved
VAVA_CAID_PU_HemophiliaFactor.pdfHemophilia factor injections to require prior authorization2017VirginiaApproved
KYKY_CAID_PU_FormularyChangeNoticeBlastFax_July2017.pdfQuarterly pharmacy formulary change notice effective July 1, 20172017KentuckyApproved
CACA_CAID_PU_FormularyChangeBlastFax_July2017.pdfQuarterly pharmacy formulary change notice effective July 1, 20177/1/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_FormularyChangeBlastFax_July2017.pdfQuarterly pharmacy formulary change notice effective July 1, 20177/1/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_ORPAWebinarPresentation.pdfORPA Webinar Presentation2017KentuckyApproved
VAVA_CAID_PU_LeadTestingFAQ.pdfLead Testing FAQ2017VirginiaApproved
KYKY_CAID_PU_VaccinesAddedtothePharmacy.pdfVaccines Added to the Pharmacy Benefit 2017KentuckyApproved
ININ_CAID_PU_2017HemophiliaFactorInjectionsPA.pdfHemophilia factor injections to require prior authorization7/14/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_WheelchairComponentorAccessory.pdfWheelchair component or accessory, not otherwise specified to require prior authorization2017KentuckyApproved
CACA_MMP_PU_PartBDrugImfinzi2017.pdfMMP Prior authorization requirements for Part B drug: Imfinzi (durvalumab)7/17/2017 12:00 AM2017CaliforniaApproved
CACA_MMP_PU_PartBDrugYondelis2017.pdfMMP Prior authorization requirements for Part B drug: Yondelis (trabectedin)7/17/2017 12:00 AM2017CaliforniaApproved
CACA_CAID_PU_2017Q1MedPoliciesCUMGUpdate.pdfQ1 Medical Policies and Clinical Utilization Management Guidelines update7/24/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_Q1MPTACNotification2017.pdfQ1 2017 MPTAC Notification 2017KentuckyApproved
ININ_CAID_PU_TemporaryNewbornCaseBulletin.pdfTemporary newborn cases7/25/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_FQHC_RHC_ClaimEncounters.pdfFederally qualified health center and rural health center claims encounters2017KentuckyApproved
WIWI_CAID_PU_2017NoticeofPregnancyIncentive.pdfPregnancy Notification Incentive2017WisconsinApproved
KYKY_CAID_PU_Hemophiliafactorinjectionrequirepriorauth.pdfHemophilia factor injections to require prior authorization2017KentuckyApproved
KYKY_CAID_PU_ProviderContactInformation.pdfKentucky Provider Important Contact Information2017KentuckyApproved
ININ_CAID_PU_UpdatedContactInformation.pdfChanges in contact information8/2/2017 12:00 AM2017IndianaApproved
WIWI_CAID_PU_CUMGUpdate_2017_Q2.pdfQ2 Medical Policies and Clinical Utilization Management Guidelines update2017WisconsinApproved
VAVA_CAID_PU_CUMGUpdate_2017_Q2.pdfQ2 Coverage Guidelines and Clinical Utilization Management Guidelines update2017VirginiaApproved
ININ_CAID_PU_WheelchairComponentOrAccessory.pdfWheelchair component or accessory, not otherwise specified to require prior authorization8/8/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_ADAcompliance.pdfAmericans with Disabilities Act compliance2017VirginiaApproved
ININ_CAID_PU_POWERAccountEstimateTool.pdfNew service estimate tool for members8/16/2017 12:00 AM2017IndianaApproved
VAVA_CCC_PU_OrthoticsRequirePriorAuth.pdfOrthotics to require prior authorization2017VirginiaApproved
KYKY_CAID_PU_PharmacyVaccinesAdded.pdfVaccines added to the pharmacy benefit2017KentuckyApproved
WIWI_CAID_PU_MedicaidAutomaticCrossover_MedicareCoordinationofbenefits.pdfMedicaid automatic crossover: Medicare coordination of benefits2017WisconsinApproved
VAVA_CAID_CCCPLUSLTSSAuthGuide.pdf Anthem CCC Plus Long-term Services and Supports Authorization Guide2017VirginiaApproved
CACA_MMP_PU_OrthoticsToRequirePriorAuth.pdfOrthotics to require prior authorization 8/25/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_DigitalSolutionsBulletin.pdfDigital self-service solutions at your fingertips 9/6/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_DurableEquiptmentPolicyChanges.pdfCA MMP Stakeholders’ Meeting Minutes – May 20179/11/2017 12:00 AM2017IndianaApproved
ININ_CAID_FaxChangeNotice.pdfMedicaid Pharmacy PA Fax Number Change12/22/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_FormularyChange.pdfQuarterly pharmacy formulary change notice effective November 1, 20179/14/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_FormularyChangeNotice_Sept12017.pdfQuarterly pharmacy formulary change notice effective November 1, 20172017KentuckyApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChange_Sept2017.pdfQuarterly pharmacy formulary change notice effective November 1, 20172017VirginiaApproved
CACA_CAID_PU_NPISurgicalCodes.pdfInclude National Provider Identifier on surgical procedure UB04 bills - MMP9/22/2017 12:00 AM2017CaliforniaApproved
VAVA_CAID_PU_NPISurgicalCodes.pdfInclude National Provider Identifier on surgical procedure UB04 bills - MMP2017VirginiaApproved
KYKY_CAID_PU_EarlyElectiveDelivery.pdfReimbursement for early elective deliveries at 37 and 38 weeks’ gestation that do not meet medical necessity criteria2019KentuckyApproved
ININ_CAID_PU_AIMGeneticTesting.pdfAIM Genetic Testing12/22/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_2017Q2MedPoliciesCUMGUpdate.pdf Q2 Medical Policies and Clinical Utilization Management Guidelines update 9/18/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_TemporaryTimelyFilingNotice.pdfTemporary modification to timely claims filing9/22/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017Q2MPCUMGUpdate.pdfQ2 Medical Policies and Clinical Utilization Management Guidelines update 9/22/2017 12:00 AM2017IndianaApproved
WIWI_CAID_PU_HealthyRewardsBehavioralHealthNotice.pdfHealthy Rewards Behavioral Health Notice2017WisconsinApproved
ININ_CAID_PU_2Q17FormularyChangeBlastFax.pdfQuarterly pharmacy formulary change notice effective November 1, 201710/3/2017 12:00 AM2017IndianaApproved
CACA_CAID_2017Q3CUMG.pdfQ3 2017 Clinical Utilization Management (UM) Guidelines10/9/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_NOCProcess.pdfNew review process for not otherwise classified drug codes2017KentuckyApproved
VAVA_CAID_PU_NOCProcess.pdfNew review process for not otherwise classified drug codes2017VirginiaApproved
WIWI_CAID_PU_NOCProcess.pdfNew review process for not otherwise classified drug codes2017WisconsinApproved
KYKY_CAID_PU_FaxChangeNoticeWeb.pdfNew Pharmacy Prior Authorization Fax Number2018KentuckyApproved
VAVA_CAID_PU_PTSDUpdateNICU.pdfNew case management program to identify PTSD in parents of infants in the NICU2017VirginiaApproved
ININ_CAID_PU_FaxAlert.pdfChanges to the durable medical equipment policy10/13/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_AntibioticOveruse2017.pdfAntibiotic overuse2017KentuckyApproved
CACA_MMP_PU_2017PartBDrugsRenflexis_Rituxan Hyclea_Zilretta.pdf MMP Prior authorization requirements for Part B drugs: Renflexis (infliximab-abda), Rituxan Hyclea (rituximab/hyaluronidase) and Zilretta (triamcinolone acetonide SR) 10/10/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_SUDPregnancyNAS.pdfSubstance use disorders in pregnancy and neonatal abstinence syndrome2017KentuckyApproved
KYKY_CAID_PU_EXPRESSDRGOutlierProcessUpdate.pdfDRG Outlier Claims Updated2017KentuckyApproved
CACA_CAID_PU_MavyretFormularyChangeFax.pdfMavyret pharmacy formulary change notice effective November 1, 201710/17/2017 12:00 AM2017CaliforniaApproved
CACA_MPU_2017AcupunctureBillingBulletin.pdfAcupuncture services effective11/1/2017 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_2017PAOpioidTreatmentEnrollment.pdfPhysician assistant and opioid treatment program enrollment10/17/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017SUDisordersPregnancyNAS.pdfSubstance use disorders in pregnancy and neonatal abstinence syndrome10/17/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_2017Q3MedPoliciesCUMGUpdate.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines update 10/18/2017 12:00 AM2017CaliforniaApproved
VAVA_CAID_PU_MavyretPharmacyFormularyChange.pdfMavyret pharmacy formulary change notice effective November 1, 20172017VirginiaApproved
KYKY_CAID_PU_MavyretFormularyChange.pdfMavyret pharmacy formulary change notice effective November 1, 20172017KentuckyApproved
VAVA_CAID_Q32017MPTACNotification.pdf Q3 Coverage Guidelines and Clinical Utilization Management Guidelines update2017VirginiaApproved
KYKY_CAID_PU_EXPRESSPTCommMtngAnnoun.pdfPharmacy and Therapeutics Advisory Committee Meeting - October 25, 20172017KentuckyApproved
WIWI_CAID_Q3_2017_MPTACNotification.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines update2017WisconsinApproved
ININ_CAID_PU_2017BillingAppropriateNPITaxonomy2.pdfBilling appropriate NPI and taxonomy — August 201710/24/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_FAQonORPAedits.pdfFrequently asked questions on Ordering, Referring, Prescribing and Attending edits2017KentuckyApproved
KYKY_CAID_PU_MPTACUpdate_2017_Q2.pdfQ2 Medical Policies and Clinical Utilization Management Guidelines update2017KentuckyApproved
ININ_CAID_PU_2017FaxExpGrievancesAppeals.pdfNew fax number for expedited member grievances and appeals10/25/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_PHandBHCollaborativeCare.pdfPhysical and behavioral health: collaborating care2017KentuckyApproved
ININ_CAID_EPARequestTool.pdfNew Pharmacy Electronic Prior Authorization (ePA) Request Tool12/22/2017 12:00 AM2017IndianaApproved
CACA_MMP_PU_TwoHealthPlanCoverageMemo.pdfTwo Health Plan Coverage via Automated Eligibility Verification System (AEVS)5/7/2018 12:00 AM2017CaliforniaApproved
ININ_CAID_PU_2017NonemergencyTransportationVendorChange.pdfChange to nonemergent transportation vendor11/8/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_Q3_2017_MPTAC_Notification.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines update 11/6/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_2017ERAutoPayProcessChange.pdfER Auto-Pay List process change11/10/2017 12:00 AM2017IndianaApproved
CACA_MMP_PU_PartBDrugsAliqopaCinvantiOpsiria.pdf MMP Prior Authorization requirements for Part B Drugs Aliqopa, Cinvanti, and Opsiria11/14/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_MedicalPolicy.pdfMedical Policy Update2017KentuckyApproved
ININ_CAID_PU_EXPRESSSuboxoneFormularyChangeBlastFax.pdfSuboxone pharmacy formulary change notice effective December 1, 201712/1/2017 12:00 AM2017IndianaApproved
KYKY_CAID_Q32017MPTACNotification.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines update2017KentuckyApproved
KYKY_CAID_PU_UpdateQ3MedicalPolicy.pdfUpdate 2017 Q3 Medical Policy 2017KentuckyApproved
KYKY_CAID_PU_FormularyChangeDEC2017.pdfQuarterly pharmacy formulary change notice effective February 1, 20182018KentuckyApproved
CACA_CAID_PU_Q3_FormularyChangeDEC2017.pdfQuarterly pharmacy formulary change notice effective February 1, 20182/1/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_2018PharmacyFormularyChange.pdfQuarterly pharmacy formulary change notice effective February 1, 20182018VirginiaApproved
ININ_CAID_PU_2017NewReviewProcessDrugCodes.pdfNew review process for not otherwise classified drug codes12/15/2017 12:00 AM2017IndianaApproved
CACA_CAID_Part BDrugsBesponsaVyxeosMMPDSNP.pdfMMP Prior authorization requirements for Part B drugs Besponsa and Vyxeos12/15/2017 12:00 AM2017CaliforniaApproved
CACA_MMP_PU_2017NewMedElectronicPARequestTool.pdfMMP New medication electronic prior authorization request tool effective January 1, 2018 12/18/2017 12:00 AM2017CaliforniaApproved
CACA_MMP_PU_2017NewPAFaxNumber.pdfMMP New pharmacy prior authorization fax number effective January 1, 201812/18/2017 12:00 AM2017CaliforniaApproved
CACA_CAID_PU_AgeLimitsFormulary.pdfAge limits pharmacy formulary change notice effective February 1, 201812/20/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_AgeLimitFormulary.pdfAge limits pharmacy formulary change notice effective February 1, 20182018KentuckyApproved
VAVA_CAID_AgeLimitsFormularyChange.pdfAge limits pharmacy formulary change notice effective February 1, 20182018VirginiaApproved
ININ_CAID_PU_NPI_TaxonomyRules.pdfNPI/Taxonomy rule reimbursements12/20/2017 12:00 AM2017IndianaApproved
VAVA_CAID_PU_PreAuthRuleLevEloHisIduFul.pdfLevoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization2018VirginiaApproved
ININ_CAID_PU_2018AgeLimitsPharmacyFormularyChange.pdfAge limits pharmacy formulary change notice effective February 1, 201812/28/2017 12:00 AM2017IndianaApproved
CACA_CAID_PU_PreAuthRuleLevEloHisIduFul.pdfLevoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization 12/28/2017 12:00 AM2017CaliforniaApproved
KYKY_CAID_PU_CodeAlignment.pdfJ codes to require pharmacy prior authorization2018KentuckyApproved
WIWI_CAID_PU_PreAuthRuleLevEloHisIduFul.pdfLevoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization2018WisconsinApproved
ININ_CAID_HIPChanges2018Notice.pdfChanges to the Healthy Indiana Plan 12/27/2017 12:00 AM2017IndianaApproved
ININ_CAID_NPI_TaxonomyRules.pdfNPI/Taxonomy Rules12/22/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_HowToCorrectDenials.pdfHow To Correct Denials12/22/2017 12:00 AM2017IndianaApproved
ININ_CAID_PU_RevTaxonomyBulletinAug2017.pdfBilling Appropriate NPI and taxonomy12/22/2017 12:00 AM2017IndianaApproved
VAVA_CAID_2017Q3CUMGUpdate.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines Updates2018VirginiaApproved
CACA_CAID_PU_2017Q3CUMGUpdate.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines Updates1/2/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_3Q17FormularyChangeBlastFax.pdfQuarterly pharmacy formulary change notice effective February 1, 20181/9/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_UpdatedCLResources.pdfUpdated Cultural and Linguistic Resources Now Available1/18/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_ElotuzumabPANotice.pdfElotuzumab to require prior authorization1/19/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_ElotuzumabPANotice.pdfElotuzumab to require prior authorization2018KentuckyApproved
VAVA_CAID_PU_ElotuzumabPANotice.pdfElotuzumab to require prior authorization2018VirginiaApproved
WIWI_CAID_PU_ElotuzumabPANotice.pdfElotuzumab to require prior authorization 2018WisconsinApproved
NVNV_CAID_PU_AgeLimitsFormularyChange_Feb2018.pdfAge limits pharmacy formulary change notice effective February 1, 20182018NevadaApproved
NVNV_CAID_PU_BHFAQs.pdfBehavioral health frequently asked questions2018NevadaApproved
NVNV_CAID_PU_PriorAuthforRehabMentalHealthServices.pdfPrior authorization process for rehabilitative mental health services2018NevadaApproved
ININ_CAID_PU_DRG_LengthsOfStay.pdfPolicies and procedures for diagnosis-related group lengths of stay1/24/2018 12:00 AM2018IndianaApproved
NVNV_CAID_PU_QuarterlyFormularyChange_Feb2018.pdfQuarterly pharmacy formulary change notice effective February 1, 20182018NevadaApproved
NVNV_CAID_PU_RebrandAnnouncement.pdfAmerigroup Community Care is now Anthem Blue Cross and Blue Shield Healthcare Solutions2018NevadaApproved
ININ_CAID_PU_DistroOpioidTreatmentProviderEnrollment.pdfOpioid Treatment Provider Enrollment1/26/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_LevoleucovorinCalciumPriorAuth.pdfPrior Authorization needed for Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant2018KentuckyApproved
KYKY_Q32017CUMGAdditionsNotice.pdf Medical Policies update2018KentuckyApproved
ININ_CAID_PU_Q3CUMGUpdateJan2018.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines Updates1/29/2018 12:00 AM2018IndianaApproved
WIWI_CAID_NewFaxNumberPharmacyPriorAuth_2018.pdfNew Fax Number for Pharmacy Medical Injectable Prior Authorization RequestsWisconsinApproved
VAVA_CAID_PU_NewFaxNumbersPharmacyPriorAuth.pdfNew Fax Numbers for Pharmacy Prior Authorization RequestsVirginiaApproved
CACA_MMP_PU_PriorAuthforRebFibHem.pdfRebinyn, Fibryna and Hemlibra 2/5/2018 12:00 AM2018CaliforniaApproved
CACA_MMP_PU_PriorAuthVarubiFasenra.pdfMMP Prior Authorization for: Varubi and Fasenra2/5/2018 12:00 AM2018California, CAMMPApproved
CACA_CAID_PU_BrineuraTremfyaInjectableZinplavaDrugs.pdf MMP Prior Authorization for: Brineura, Tremfya and Zinplava2/5/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_Elotuzumab.pdfElotuzumab to require prior authorization 2/6/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_OpioidDisorderCourseFlyer.pdfFebruary 24 Treatment of Opioid Disorder Course Flyer2018KentuckyApproved
KYKY_CAID_PU_OpioidDisorderCourseFlyer_March10.pdfMarch 10 Treatment of Opioid Disorder Course Flyer2018KentuckyApproved
KYKY_CAID_PharmandTherapAdvisoryCommitteeMeetingDates2018.pdfPharmacy and Therapeutics Advisory Committee 2018 Meeting DatesKentuckyApproved
VAVA_CCC_PU_Eightinjectdrugsrequirepriorauth.pdfAnthem CCC Plus Eight injectable drugs will require prior authorization2018Virginia, VA MMPApproved
VAVA_CAID__PU_EightInjectdrugsrequirepriorauth.pdfEight injectable drugs will require prior authorization2018VirginiaApproved
KYKY_CAID_PU_ReimbursementForEarlyElectiveDeliveries.pdfReimbursement for Early Elective Deliveries2018KentuckyApproved
WIWI_CAID_InjectableDrugsMCD.pdfEight injectable drugs will require prior authorization2/14/2018 12:00 AM2018WisconsinApproved
CACA_CAID_InjectableDrugsMCD.pdfEight injectable drugs will require prior authorization2/14/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_NoticetoEMSProviders_Feb2018.pdfNotice to EMS Providers2018KentuckyApproved
CACA_CAID_PU_AIMMusculoskeletalNotice.pdfAIM Musculoskeletal Guidelines2/13/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PU_ICSPharmFormChangeNotice.pdfICS Pharmacy Formulary Change Notice2018NevadaApproved
CACA_CAID_PU_ICSPharmFormChangeNotice.pdfICS Pharmacy Formulary Change Notice2/19/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_PharmFormularyChangeNotice.pdfICS Pharmacy Formulary Change Notice2/19/2018 12:00 AM2018IndianaApproved
VAVA_CAID_PU_PhamFormChangeNotice_2-19.pdfICS Pharmacy Formulary Change Notice2/19/2018 12:00 AM2018VirginiaApproved
VAVA_CAID_PU_UMAffirmativeStatement.pdf2018 Utilization Management Affirmative Statement 2018VirginiaApproved
VAVA_CCC_PU_UMAffirmativeStatement.pdfAnthem CCC Plus 2018 Utilization Management Affirmative Statement2018Virginia, VA MMPApproved
CACA_CAID_PU_UMAffirmativeStatement.pdf2018 Utilization Management Affirmative Statement 2/20/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_UMAffirmativeStatement.pdf2018 Utilization Management Affirmative Statement 2018KentuckyApproved
WIWI_CAID_PU_UMAffirmativeStatement.pdf2018 Utilization Management Affirmative Statement 2018WisconsinApproved
CACA_CAID_PU_HyaluronanInjectionsUpdate.pdfMedical Policy update - Hyaluronan Injections 2/19/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_HyaluronanInjectionsUpdate.pdfMedical Policy update - Hyaluronan Injections 2/19/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_HyaluronanInjectionsUpdate.pdfMedical Policy update - Hyaluronan Injections 2/19/2018 12:00 AM2018WisconsinApproved
NVNV_CAID_PU_2018ProViewforCredentialing.pdfEffective June 1, 2018, providers will be required to use ProView for credentialing2018NevadaApproved
KYKY_CAID_PU_MultiRadiologyProcedurePayReduct.pdfMultiple Radiology Payment Reduction2018KentuckyApproved
KYKY_CAID_PU_RadiologyBenefitManagement.pdfUpdate to radiology benefit management2018KentuckyApproved
ININ_CAID_PU_First8visitsofTherapyProviderBulletin.pdfFirst 8 Visits of Therapy Provider Bulletin2/27/2018 12:00 AM2018IndianaApproved
CACA_PU_UM_Affirmation_Statement.pdfMMP 2018 Utilization Management Affirmative Statement2/27/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_IMDExclusionRule.pdfMedicaid Institutions for Mental Diseases Exclusion Rule2018KentuckyApproved
KYKY_CAID_PU_Claimsbilledmodifiers.pdfClaims billed with modifiers GR, GY, GX and GZ2018KentuckyApproved
KYKY_CAID_PU_NonpricedCodesEffective_4_15_18.pdfParticipating hospitals: nonpriced codes effective April 15, 2018 2018KentuckyApproved
KYKY_CAID_PU_PrecertificationChanges.pdfChanges to precertification2018KentuckyApproved
NVNV_CAID_PU_EXPRESSPreAuthRuleLevEloHisIduFul.pdfLevoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization (3/12/18)2018NevadaApproved
CACA_CAID_PartBDrugsMylotargMvasi.pdf MMP Prior authorization requirements for Part B drugs: Mylotarg and Mvasi3/12/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_EXPRESSPrecertforSUDServices.pdfPrecertification for certain substance use disorder services3/13/2018 12:00 AM2018IndianaApproved
NVNV_CAID_AIMMusculoskeletalNotice.pdfAIM Musculoskeletal Guidelines Notification effective March 1, 20182018NevadaApproved
ININ_CAID_PU_AIMMusculoskeletalNotice.pdfAIM Musculoskeletal Guidelines 3/21/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_BillingGuidelinesforTransgenderMembers.pdfBilling Guidelines for Transgender Members2018KentuckyApproved
CACA_CAID_PU_MylotargDrugPrecertificationUpdate.pdfPrior authorization requirement update for Mylotarg3/20/2018 12:00 AM2018CaliforniaApproved
VAVA_CCC_PU_ MylotargDrugPrecertificationUpdate.pdfAnthem CCC Plus Prior authorization requirement update for Mylotarg 3/20/2018 12:00 AM2018VirginiaApproved
VAVA_CAID_MylotargDrugPrecertificationUpdate.pdfPrior authorization requirement update for Mylotarg3/20/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_MylotargDrugPrecertificationUpdate.pdfPrior authorization requirement update for Mylotarg3/20/2018 12:00 AM2018WisconsinApproved
CACA_CAID_PU_Q4CUMGNotif.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Updates4/23/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PU_Q4CUMGNotif.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Updates 3/19/2018 12:00 AM2018NevadaApproved
VAVA_CAID_PU_Q4CUMGNotif.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Updates 3/19/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_Q4CUMGNotif.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Updates 3/19/2018 12:00 AM2018WisconsinApproved
ININ_CAID_PAsPMPs.pdfPhysicians assistants may now serve as primary medical providers3/26/2018 12:00 AM2018IndianaApproved
NVNV_CAID_PU_Elotuzumabrequirepriorauth.pdfElotuzumab to require prior authorization2018NevadaApproved
CACA_CAID_EXPRESSNewMedicareCards.pdfNew Original Medicare ID Cards on the Way3/30/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_Changestoprecertification.pdfChanges to Precertification2018KentuckyApproved
CACA_CAID_HomeHealthBillingBulletin.pdfHome Health Nursing Visits Updates: Effective2/8/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_UMAffirmationStatement.pdf2018 Utilization Management Affirmative Statement 4/3/2018 12:00 AM2018IndianaApproved
VAVA_CAID_PharmacyFormularyChangeNotice_2018_Q1.pdfQuarterly pharmacy formulary change notice effective May 1, 20182018VirginiaApproved
NVNV_CAID_PU_QuarterlyFormularyChange_May2018.pdfQuarterly pharmacy formulary change notice effective May 1, 20182018NevadaApproved
CACA_CAID_PU_FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective May 1, 20184/6/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_MedlineBreastPumpNotif.pdfMedline Breast Pump Notification and Form 4/5/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_2017CUMGNotif.pdfQ4 Medical Policies and Clinical Utilization Management Guidelines Updates4/4/2018 12:00 AM2018IndianaApproved
NVNV_CAID_PU_WAVEQ3CUMGMPAdditions.pdfQ3 Medical Policies and Clinical Utilization Management Guidelines Updates2018NevadaApproved
CACA_CAID_PU_PartBDrugsZavalinEptacog.pdf MMP Prior authorization requirements for Part B drugs: ZEVALIN and Eptacog 4/6/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_4Q17FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective May 1, 20184/5/2018 12:00 AM2018IndianaApproved
KYKY_PU_HyaluronanInjectionsUpdate.pdfMedical Policy update - Hyaluronan Injections2018KentuckyApproved
ININ_CAID_PU_UpdatedInformationAuthorizatiions.pdfUpdated information for prior authorizations4/12/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_WAVENursingBenefitExhaustion.pdfSkilled nursing facility (SNF) benefits and medical necessity reviews4/9/2018 12:00 AM2018IndianaApproved
WIWI_CAID_MedicaidKeyContactList.pdfMedicaid Key Contact List2018WisconsinApproved
ININ_CAID_PU_WAVEBillingPostpartumVisits.pdfBilling for postpartum visits4/17/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_ElectricalStimulationDevice.pdfMMP Electrical stimulation device to require prior authorization4/20/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_TCellTherapyRequirement.pdfMMP Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service4/20/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_ElectriStimulaDevice.pdfElectrical stimulation device to require prior authorization4/20/2018 12:00 AM2018VirginiaApproved
VAVA_CAID_PU_CAR_T_TherapyNotice.pdfChimeric antigen receptor T-cell therapy requires prior authorization for all places of service 4/20/2018 12:00 AM2018VirginiaApproved
CACA_CAID_PU_ChimericAntigenReceptor.pdfChimeric antigen receptor T-cell therapy requires prior authorization for all places of service4/20/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PeerSupportsInformationalFlier.pdfPeer Support Services Flier2018NevadaApproved
CACA_MMP_PU_PriorAuthReqCardiovascularService2018.pdfMMP Prior authorization requirements for cardiovascular services 4/24/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PU_HyaluronanInjectionsUpdate.pdfMedical Policy update - Hyaluronan Injections2018NevadaApproved
CACA_CAID_PU_TrelstarPartBDrug.pdfMMP Prior authorization requirement for Part B drug: Trelstar 4/30/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_CARTTherapyNotice.pdfChimeric antigen receptor T-cell therapy requires prior authorization for all places of service2018KentuckyApproved
CACA_MMP_ProviderDirectory2018_TAG_MayAddendum.pdfProvider and Pharmacy Directory - May Addendum - Tagalog5/1/2018 12:00 AM2018CAMMPApproved
CACA_MMP_ProviderDirectory2018_VIET_MayAddendum.pdfProvider and Pharmacy Directory - May Addendum - Vietnamese5/1/2018 12:00 AM2018CAMMPApproved
WIWI_CAID_WAVELowerExtrVascularIntervcodes.pdfLower extremity vascular intervention codes require prior authorization5/2/2018 12:00 AM2018WisconsinApproved
VAVA_CAID_WAVELowerExtrVascularIntervcodes.pdfLower extremity vascular intervention codes require prior authorization5/2/2018 12:00 AM2018VirginiaApproved
VAVA_CAID_PU_DarzalexPriorAuthReq.pdfPrior authorization requirements for Darzalex drug2018VirginiaApproved
CACA_CAID_PU_DarzalexPriorAuthReq.pdfPrior authorization requirements for Darzalex drug5/3/2018 12:00 AM2018CaliforniaApproved
WIWI_CAID_PU_DarzalexPriorAuthReq.pdfPrior authorization requirements for Darzalex drug2018WisconsinApproved
VAVA_CAID_PU_ICSFormularyChangeNotice.pdfICS pharmacy formulary change notice update: effective April 15, 20182018VirginiaApproved
CACA_CAID_PU_ServicesRequiringPriorAuth.pdfServices requiring prior authorization5/4/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_ServicesRequiringPriorAuth.pdfServices requiring prior authorization2018VirginiaApproved
WIWI_CAID_PU_ServicesRequiringPriorAuth.pdfServices requiring prior authorization2018WisconsinApproved
NVNV_CAID_ICSFormularyChangeNoticeUpdate.pdfICS pharmacy formulary change notice update: effective April 15, 20182018NevadaApproved
KYKY_CAID_PU_ICSFormularyChangeNoticeUpdate.pdfICS pharmacy formulary change notice update: effective April 15, 20182018KentuckyApproved
ININ_CAID_ICSFormularyChangeNoticeUpdate.pdfICS pharmacy formulary change notice update: effective April 15, 20185/8/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_ICSFormularyChangeNoticeUpdate.pdfICS pharmacy formulary change notice update: effective April 15, 20185/2/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_PAReqUpdateMylotarg.pdfPrior authorization requirement update for Mylotarg2018KentuckyApproved
CACA_CAID_PU_EXPRESSIHCBilling.pdfIndian Health Centers, Enhanced Payment, Billing Instructions5/10/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_ExpressIHCBulletin.pdfIndian Health Centers, Enhanced Payment5/10/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_Prop56Cover.pdfProposition 565/10/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_ZepatierCoughCold.pdfZepatier, cough and cold pharmacy formulary change notice effective June 1, 20185/10/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_ADTReportOnAvaility2018.pdfNew Admission, Discharge and Transfer on the Availity Portal5/10/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_ElectriStimulaDevicePriorAuthReqAnthem.pdfElectrical stimulation device to require prior authorization5/18/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_CoughandColdFormularyChange.pdfCough and cold pharmacy formulary change notice effective June 1, 20185/18/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_ZepatierCCFormularyChange.pdfZepatier, cough and cold pharmacy formulary change notice effective June 1, 20185/18/2018 12:00 AM2018KentuckyApproved
KYKY_CAID_PU_ValueBasedPaymentNotification.pdfValue Based Payment Notification2018KentuckyApproved
NVNV_CAID_PU_ZepatierCoughColdFormularyChange_May2018.pdfZepatier, cough and cold pharmacy formulary change notice effective June 1, 20182018NevadaApproved
VAVA_CAID_PU_ZepatierCoughColdFormularyChange_May2018.pdfZepatier, cough and cold pharmacy formulary change notice effective June 1, 20182018VirginiaApproved
ININ_CAID_PU_ClaimDenialCodesG18and256.pdfClaims denials for codes G18 and 2565/22/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PrecertificationChanges.pdfChanges to Precertification - Place of Service (POS) 32 Skilled Nursing Facilities (SNF)2018KentuckyApproved
CACA_CAID_PU_2017DeletedCodesOnly.pdf2017 HCPCS-CPT Code Deletions5/23/2018 12:00 AM2017CaliforniaApproved
CACA_CAID_PU_AttendingNPIReqComm.pdfNew Attending NPI Information Requirement for Non-capitated Claims 5/23/2018 12:00 AM2017CaliforniaApproved
CACA_CAID_PU_PM160FormClarification.pdfPM 160 Form Clarification5/23/2018 12:00 AM2017CaliforniaApproved
CACA_CAID_PU_Prop56Payments.pdfProposition 56 - Update5/23/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_MepolizumabReslizumabPriorAuth.pdfPrior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)5/24/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_MepolizumabReslizumabPriorAuth.pdfPrior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)2018VirginiaApproved
WIWI_CAID_PU_MepolizumabReslizumabPriorAuth.pdfPrior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)2018WisconsinApproved
CACA_CAID_PriorAuthCabazitaxel.pdfPrior authorization requirements for Cabazitaxel5/24/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PriorAuthCabazitaxel.pdfPrior authorization requirements for Cabazitaxel2018VirginiaApproved
CACA_MMP_ProviderDirectory2018_ENG_JuneAddendum.pdfProvider and Pharmacy Directory - June Addendum- English5/30/2018 12:00 AM2018CAMMPApproved
CACA_MMP_ProviderDirectory2018_CHI_JuneAddendum.pdfProvider and Pharmacy Directory - June Addendum - Chinese5/30/2018 12:00 AM2018CAMMPApproved
CACA_MMP_ProviderDirectory2018_SPN_JuneAddendum.pdfProvider and Pharmacy Directory - June Addendum - Spanish5/30/2018 12:00 AM2018CAMMPApproved
CACA_MMP_ProviderDirectory2018_VIET_JuneAddendum.pdfProvider and Pharmacy Directory - June Addendum - Vietnamese5/30/2018 12:00 AM2018CAMMPApproved
CACA_MMP_ProviderDirectory2018_TAG_JuneAddendum.pdfProvider and Pharmacy Directory - June Addendum - Tagalog5/30/2018 12:00 AM2018CAMMPApproved
ININ_CAID_2017Q4CUMG.pdfQ4 2017 Clinical Utilization Management Guidelines5/31/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_HospiceProviderBulletin.pdfHospice prior authorizations8/30/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_InjectableDrugsMCD.pdfEight injectable drugs will require prior authorization6/6/2018 12:00 AM2018KentuckyApproved
ININ_CAID_PU_ElectriStimulaDevicePAReq.pdfElectrical stimulation device to require prior authorization5/31/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_2018PhysicianAdminDrugNDC.pdfPhysician-administered drugs: reporting National Drug Codes 6/7/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_Prop56PaymentInfo.pdfProposition 56 Payment Information6/13/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_PhysicalBHCollaborative.pdfPhysical and behavioral health collaborative care2018KentuckyApproved
CACA_CAID_PU_MCG22ndEd.pdfAnthem Blue Cross adopts 22nd edition of the MCG care guidelines6/13/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_MCG22ndEd.pdfHealthKeepers, Inc. adopts 22nd edition of the MCG care guidelines2018VirginiaApproved
WIWI_CAID_PU_MCG22ndEd.pdfAnthem Blue Cross and Blue Shield adopts 22nd edition of the MCG care guidelines2018WisconsinApproved
NVNV_CID_PU_CAR-TTherapyNotice.pdfChimeric antigen receptor T-cell therapy requires prior authorization for all places of service2018NevadaApproved
NVNV_CID_PU_ElectriStimulaDevicePriorAuthReq.pdfElectrical stimulation device to require prior authorization2018NevadaApproved
NVNV_CID_PU_InjectableDrugsMCD.pdfEight injectable drugs will require prior authorization2018NevadaApproved
NVNV_CID_PU_WAVELowerExtrVascularIntervCodes.pdfLower extremity vascular intervention codes require prior authorization2018NevadaApproved
NVNV_CAID_PU_MylotargDrugPrecertUpdate.pdfPrior authorization requirement update for Mylotarg2018NevadaApproved
ININ_CAID_PU_VaccineAdminDenials.pdfVaccine administration denials6/20/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_CabazitaxelDrugPA.pdfPrior authorization requirements for Cabazitaxel (Jevtana)6/25/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_CAR-TTherapyNotice.pdfChimeric antigen receptor T-cell therapy requires prior authorization for all places of service6/25/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_WAVELowerExtrVascularIntervcodes.pdfLower extremity vascular intervention codes require prior authorization7/9/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PemetrexedDrugAuthRequired.pdfPrior authorization requirements for drug pemetrexed6/26/2018 12:00 AM2018KentuckyApproved
NVNV_CAID_PU_ReminderUpdateProvider.pdf Provider directory update6/26/2018 12:00 AM2018NevadaApproved
KYKY_CAID_LARCUpdate.pdfLong-Acting Reversible Contraception Update: Effective February 1, 20182018KentuckyApproved
NVNV_CAID_LARCUpdate.pdfLong-Acting Reversible Contraception Update: Effective February 1, 20182018NevadaApproved
KYKY_CAID_PrecertificationChangesPPEC.pdfChanges to prior authorization2018KentuckyApproved
CACA_CAID_PU_QuarterlyFormularyChange_8-1-2018.pdfQuarterly pharmacy formulary change notice effective August 1, 20186/29/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_QuarterlyFormularyChange_8-1-2018.pdfQuarterly pharmacy formulary change notice effective August 1, 20182018KentuckyApproved
NVNV_CAID_PU_QuarterlyFormularyChange_8-1-2018.pdfQuarterly pharmacy formulary change notice effective August 1, 20182018NevadaApproved
VAVA_CAID_PU_QuarterlyFormularyChange_8-1-2018.pdfQuarterly pharmacy formulary change notice effective August 1, 20182018VirginiaApproved
CACA_MMP_PU_AzedraPoteligeoPartB.pdfMMP Prior authorization requirements for Azedra and Poteligeo 7/2/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PhysicianRadiologyRedirection.pdfPhysician radiology redirection7/9/2018 12:00 AM2018NevadaApproved
CACA_CAID_PU_Jan2018CUMGNotifi.pdfJanuary Medical Policies and Clinical Utilization Management Guidelines update7/9/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_18Jan2018CUMGNotifi.pdfJanuary - 2018 Medical Policies and Clinical Utilization Management Guidelines update7/9/2018 12:00 AM2018KentuckyApproved
NVNV_CAID_PU_Jan2018CUMGNotifi.pdfJanuary - 2018 Medical Policies and Clinical Utilization Management Guidelines update7/9/2018 12:00 AM2018NevadaApproved
VAVA_CAID_PU_Jan2018CUMGNotifi.pdfJanuary - 2018 Medical Policies and Clinical Utilization Management Guidelines update7/9/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_Jan2018CUMGNotifi.pdf Medical Policies and Clinical Utilization Management Guidelines update - January 20187/9/2018 12:00 AM2018WisconsinApproved
ININ_CAID_PU_ReconsiderationProvBulletin.pdfReconsideration process7/10/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_PemetrexedDrugAuthRequired.pdfPA requirements for pemetrexed (ALIMTA)2018KentuckyApproved
ININ_CAID_PU_ProBehalfMbr.pdfMember appeal or grievance7/9/2018 12:00 AM2018IndianaApproved
WIWI_CAID_PU_ICRFlierUpdate.pdfAccess Interactive Care Reviewer via Availity Portal7/16/2018 12:00 AM2018WisconsinApproved
NVNV_CAID_PU_UMAffirmationStatement.pdf2018 Utilization Management Affirmative Statement7/17/2018 12:00 AM2018NevadaApproved
ININ_CAID_PU_RetroactiveEligibility.pdfRetroactive eligibility — prior authorization/utilization management and claims processing 6/12/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_PriorAuthRetacritDamocIlumya.pdfMMP Prior authorization requirements for Part B drugs: Retacrit, Damoctocog and Ilumya7/20/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_22ndEditionMCGCareGuidelines.pdfAnthem Blue Cross and Blue Shield adopts 22nd edition of the MCG care guidelines7/20/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_CUMG_March_2018.pdfMarch Medical Policies and Clinical Utilization Management Guidelines update7/16/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_CUMG_March_2018.pdfMarch - 2018 Medical Policies and Clinical Utilization Management Guidelines update7/16/2018 12:00 AM2018KentuckyApproved
NVNV_CAID_PU_CUMG_March_2018.pdfMarch - 2018 Medical Policies and Clinical Utilization Management Guidelines update7/16/2018 12:00 AM2018NevadaApproved
VAVA_CAID_PU_CUMG_March_2018.pdfMarch - 2018 Medical Policies and Clinical Utilization Management Guidelines update7/16/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_CUMG_March_2018.pdfMarch Medical Policies and Clinical Utilization Management Guidelines update7/16/2018 12:00 AM2018WisconsinApproved
CACA_CAID_MP_CUMG_Jan2018.pdfJanuary 2018 Clinical Utilization Management Guidelines7/6/2018 12:00 AM2018CaliforniaApproved
WIWI_CAID_MP_CUMG_Jan2018.pdfJanuary 2018 Clinical Utilization Management Guidelines7/6/2018 12:00 AM2018WisconsinApproved
KYKY_CAID_PU_WAVEUsemiscellaneouscodes.pdfMiscellaneous durable medical equipment billing guidelines2018KentuckyApproved
ININ_CAID_PU_ReminderaboutMedicaidrecordspolicy.pdfReminder about Medicaid records policy7/20/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_NotificationReminderRegardingLockInSpecialist.pdfNotification reminder regarding lock-in specialist referrals2018KentuckyApproved
VAVA_CAID_PU_ProviderOrientationInvite2018.pdfProvider Orientation Invite2018VirginiaApproved
NVNV_CAID_PU_WAVEUsemiscellaneouscodes.pdfMiscellaneous durable medical equipment billing guidelines2018NevadaApproved
ININ_CAID_PU_PreviouslyDeniedPostpartumCareClaims.pdfPreviously denied postpartum care claims7/24/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_RPUpdateMultipleRadiologyReduction.pdfMultiple Radiology Payment Reduction Reimbursement Policy Update2018KentuckyApproved
KYKY_CAID_PU_HepatitisAVaccineUpdate.pdfHepatitis A vaccine update2018KentuckyApproved
NVNV_CAID_PU_DarzalexPriorAuthReq_July_2018.pdfPrior authorization requirements for Darzalex drug2018NevadaApproved
NVNV_CAID_PU_ServicesRequiringPriorAuth_July_2018.pdfServices requiring prior authorization2018NevadaApproved
KYKY_CAID_PU_CabazitaxelDrugPrior.pdfPrior authorization requirements for Cabazitaxel8/1/2018 12:00 AM2018KentuckyApproved
KYKY_CAID_PU_DarzalexDrugPrio.pdfPrior authorization requirements for Darzalex drug8/1/2018 12:00 AM2018KentuckyApproved
KYKY_CAID_PU_MepolizumabReslizumab.pdfMepolizumab and reslizumab8/1/2018 12:00 AM2018KentuckyApproved
ININ_CAID_PU_OutpatientTherapyBenefitLimitReminders.pdfOutpatient therapy benefit limit reminders7/31/2018 12:00 AM2018IndianaApproved
WIWI_CAID_PU_Changepaymentmethodinpatientclaims.pdfChange to payment method for inpatient claims2018WisconsinApproved
CACA_CAID_PU_SameDayPCPChange.pdfSame Day PCP Change2018CaliforniaApproved
CACA_CAID_PU_CUMGUpdate_August2018.pdfMay Medical Policies and Clinical Utilization Management Guidelines update8/7/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PU_PostPaymentReviews.pdfAnthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) to conduct post-payment reviews of distinct procedural services modifiers2018NevadaApproved
ININ_CAID_LevelOfCareSpecialtyRxFax.pdfLevel of care for administration of specialty drugs8/15/2018 12:00 AM2018IndianaApproved
WIWI_CAID_MP_CUMG_May2018.pdfMay 2018 Medical Policies and Clinical Utilization Management Guidelines update2018WisconsinApproved
CACA_CAID_PU_HospiceBillingInstructions_8-21-18.pdfHospice Billing Instructions8/21/2018 12:00 AM2018CaliforniaApproved
NVNV_CAID_PU_CabazitaxelPA.pdfPrior authorization requirements for Cabazitaxel2018NevadaApproved
KYKY_CAID_PU_May2018MPTACNotification.pdfMedical Policies and Clinical Utilization Management Guidelines update - May 20182018KentuckyApproved
VAVA_CAID_PU_May2018MPTACNotification.pdfMedical Policies and Clinical Utilization Management Guidelines update - May 20182018VirginiaApproved
WIWI_CAID_PU_SomatremPAR_8-2018.pdfPrior authorization requirements for Somatrem8/24/2018 12:00 AM2018WisconsinApproved
VAVA_CAID_PU_SomatremPAR_8-2018.pdfPrior authorization requirements for Somatrem8/24/2018 12:00 AM2018VirginiaApproved
CACA_CAID_PU_SomatremPAR_8-24-2018.pdfPrior authorization requirements for Somatrem8/24/2018 12:00 AM2018CaliforniaApproved
CACA_CAID_PU_InterferonBetaDrugPAR_8-22-2018.pdfPrior authorization requirements for Interferon beta-1a8/22/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_InterferonBetaDrugPAR_8-22-2018.pdfPrior authorization requirements for Interferon beta-1a8/22/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_InterferonBetaDrugPAR_8-22-2018.pdfPrior authorization requirements for Interferon beta-1a8/22/2018 12:00 AM2018WisconsinApproved
ININ_CAID_PU_1Q18FormularyChange.pdfQuarterly pharmacy formulary change notice effective August 1, 20188/24/2018 12:00 AM2018IndianaApproved
ININ_CAID_EEDReimbPolicyUpdate.pdfEarly elective delivery reimbursement policy update8/27/2018 12:00 AM2018IndianaApproved
CACA_MMP_PU_PartBDrugsMoxetumomabCemiplimabFulphilaPAR_8-28-18.pdfCA MMP Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila8/28/2018 12:00 AM2018California, CAMMPApproved
NVNV_CAID_PU_MepolizumabReslizumab.pdfPrior authorization requirements for injectable/infusible drugs: mepolizumab and reslizumab2018NevadaApproved
CACA_CAID_PU_ProjectRetinaRxWave7ePACMM.pdfNew pharmacy electronic prior authorization request tool effective November 4th, 20188/31/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_WAVE_UseofmisccodesE1399.pdfUse of miscellaneous codes E13998/30/2018 12:00 AM2018IndianaApproved
WIWI_CAID_PU_HighLevelTesting.pdfPrior authorization requirements for high-level, definitive drug testing2018WisconsinApproved
NVNV_CAID_PU_ERAutoPayList_Sept_2018.pdfER auto-pay list2018NevadaApproved
NVNV_CAID_PU_QuarterlyFormularyChange_10-1-2018.pdfQuarterly pharmacy formulary change notice effective October 1, 20182018NevadaApproved
NVNV_CAID_PU_PriorAuthSomatrem.pdfPrior authorization requirements for Somatrem 2018NevadaApproved
NVNV_CAID_PU_OTCFormularyChangeBlastFax.pdfOTC formulary change notice effective October 1, 20182018NevadaApproved
ININ_CAID_PU_InpatientStayReqforMedSvcsPolicyChanges_9-6-2018.pdfInpatient stay and request for medical services policy changes9/6/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_OTCFormularyChangeBlastFax.pdfOTC formulary change notice effective October 1, 20189/12/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_QuarterlyFormularyChange_10-1-2018.pdfQuarterly pharmacy formulary change notice effective October 1, 20189/10/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_EXPRESSProviderData.pdfProvider data validation survey9/14/2018 12:00 AM2018KentuckyApproved
KYKY_CAID_PU_KY2Q18FormularyChangeBlastFax.pdfQuarterly pharmacy formulary change notice effective October 1, 20182018KentuckyApproved
KYKY_CAID_PU_ReminderPrecertificationPainManagementServices_Sep_2018.pdfReminder: precertification for pain management services2018KentuckyApproved
ININ_CAID_AppliedBehavioralAnalysisUMGuideline_Sep_2018.pdfIndiana Medicaid Applied Behavioral Analysis UM Guideline9/17/2018 12:00 AM2018IndianaApproved
VAVA_2Q18FormularyChangeBlastFax.pdfQuarterly pharmacy formulary change notice effective October 1, 20182018VirginiaApproved
VAVA_CAID_PU_PrecertificationRequirements_10-5-2018.pdfPrecertification requirements effective October 5, 20182018VirginiaApproved
KYKY_CAID_PU_AnthemmedicaidOE.pdfMedicaid member open enrollment9/25/2018 12:00 AM2018KentuckyApproved
KYKY_CAID_PA_InjectionSomatrem.pdfPrior authorization requirements for Somatrem9/26/2018 12:00 AM2018KentuckyApproved
NVNV_CAID_PU_CUMGUpdate_May2018.pdfMay 2018 Medical Policies and Clinical Utilization Management Guidelines Update2018NevadaApproved
KYKY_CAID_PU_CUMGUpdate_2017_Q4.pdfMedical Policies and Clinical Utilization Management Guidelines update - Q4 20172017KentuckyApproved
KYKY_CAID_PU_RightsandRespofBlueCrossBlueShield.pdfRights and responsibilities of Anthem Blue Cross and Blue Shield Medicaid Members2018KentuckyApproved
ININ_CAID_PU_WAVEClarifPolicies.pdf Clarification of Policies and Procedures9/28/2018 12:00 AM2018IndianaApproved
WIWI_CAID_STATE_DHS_OpioidUseDisorder.pdfOpioid Use Disorder – Doing More for Patients2018WisconsinApproved
KYKY_CAID_PU_CervLengthMeasbyTU.pdfCervical length measurement by transvaginal ultrasound9/27/2018 12:00 AM2018KentuckyApproved
NVNV_CAID_PU_CervLengthMeasbyTU.pdfCervical length measurement by transvaginal ultrasound9/27/2018 12:00 AM2018NevadaApproved
VAVA_CAID_PU_CervLengthMeasbyTU.pdfCervical length measurement by transvaginal ultrasound9/27/2018 12:00 AM2018VirginiaApproved
NVNV_CAID_MCGforPH_AcuteCareServices_Oct_2018.pdfAnthem Blue Cross and Blue Shield Healthcare Solutions adopts MCG Care Guidelines for Physical Health2018NevadaApproved
KYKY_CAID_ReimburseChangeMidLevelPractitioners_Oct_2018.pdfReimbursement Change for Midlevel Practitioners2018KentuckyApproved
WIWI_CAID_PU_MSKAIMProviderAnnouncement.pdfTransition of musculoskeletal programs10/8/2018 12:00 AM2018WisconsinApproved
CAMMP_CAID_PU_PartBDrugNivestym.pdfCA MMP Prior authorization requirements for Part B drug Nivestym9/28/2018 12:00 AM2018CaliforniaApproved
CAMMP_CAID_PU_SantaClaraMMPNetworkUpdate_Oct_2018.pdfSanta Clara MMP Network Update: CareMore Health10/9/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_TaxonomyCodeBilling.pdfTaxonomy code billing requirement change for FQHC and RHC Providers2018KentuckyApproved
ININ_CAID_PU_CervLengthMeasby.pdfCervical length measurement by transvaginal ultrasound12/6/2018 12:00 AM2018IndianaApproved
NVNV_CAID_AvailityClaimPaymentDisputesWebinar_Oct_2018.pdfAvaility Claim Payment Disputes Webinar10/22/2018 12:00 AM2018NevadaApproved
CACA_CAID_PU_PrenatalFormularyChangeNotice.pdfPrenatal formulary change notice effective August 1, 201810/24/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_PU_PrenatalFormularyChangeNotice.pdfPrenatal formulary change notice effective August 1, 201810/24/2018 12:00 AM2018IndianaApproved
VAVA_CAID_PU_PrenatalFormularyChangeNotice.pdfPrenatal formulary change notice effective August 1, 201810/24/2018 12:00 AM2018VirginiaApproved
ININ_CAID_PU_HEDISDevelopAssessment_Oct_2018.pdfClarification on medical record requirements for physical and mental development history10/24/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_ClinicalGuidanceMothersOpioidUse_Oct_2018.pdfClinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants2018KentuckyApproved
VAVA_CAID_PU_ClinicalGuidanceMothersOpioidUse_Oct_2018.pdfClinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants2018VirginiaApproved
WIWI_CAID_PrenatalUltrasoundReimb_Oct_2018.pdfPrenatal ultrasound reimbursement update10/26/2018 12:00 AM2018WisconsinApproved
NVNV_CAID_PU_PrenatalFormularyChangeNotice.pdfPrenatal formulary change notice effective August 1, 20182018NevadaApproved
ININ_CAID_PU_AddressChangeReminder_Oct_2018.pdfAddress change reminder10/25/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_QuarterlyPharmFormularyChange_Oct_2018.pdfQuarterly pharmacy formulary change notice effective October 1, 201810/26/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_SubcutaneousImplantableDefibrillator.pdfPrior authorization requirements for Subcutaneous Implantable Defibrillator system10/31/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_SubcutaneousImplantableDefibrillator.pdfPrior authorization requirements for Subcutaneous Implantable Defibrillator system2018VirginiaApproved
WIWI_CAID_PU_SubcutaneousImplantableDefibrillator.pdfPrior authorization requirements for Subcutaneous Implantable Defibrillator system2018WisconsinApproved
WIWI_CAID_PU_OrthonetRehabDecommission.pdfTransition of Outpatient Rehabilitation Utilization Management Program effective January 1, 20192018WisconsinApproved
CACA_CAID_PriorAuthFormForProviders_Oct_2018.pdfUpdated Prior Authorization Form for Providers10/31/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_PU_Sublocade.pdfPrior authorization requirements for Sublocade11/1/2018 12:00 AM2018KentuckyApproved
VAVA_CAID_PU_Sublocade.pdfPrior authorization requirements for Sublocade11/1/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_Sublocade.pdfPrior authorization requirements for Sublocade11/1/2018 12:00 AM2018WisconsinApproved
ININ_CAID_PU_EXPRESSQ3Providerbulletin.pdfThird quarter updates11/6/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_Hospitaladmissionspolicy.pdfHospital admissions policy update11/6/2018 12:00 AM2018IndianaApproved
WIWI_CAID_NewbornInpatientStays.pdfNormal newborn diagnosis-related group claims processing update2018WisconsinApproved
ININ_CAID_PU_SubcutaneousImplantableDefib.pdfPrior authorization requirements for Subcutaneous Implantable Defibrillator system10/31/2018 12:00 AM2018IndianaApproved
NVNV_CAID_CUMGUpdate2018.pdfJuly 2018 Medical Policies and Clinical Utilization Management Guidelines update2018NevadaApproved
VAVA_CAID_MPTACJuly2018.pdfJuly 2018 Medical Policies and Clinical Utilization Management Guidelines update2018VirginiaApproved
ININ_CAID_PU_May2018CUMG.pdfMay 2018 Medical Policies and Clinical Utilization Management Guidelines Update9/26/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_NotifJuly2018.pdfJuly 2018 Medical Policies and Clinical Utilization Management Guidelines Update11/26/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_3Q18FormularyChng.pdfQuarterly pharmacy formulary change notice effective January 1, 201911/28/2018 12:00 AM2019VirginiaApproved
KYKY_CAID_PU_EXPRESSCopayUpdate.pdfCopay updates for specific services11/29/2018 12:00 AM2018KentuckyApproved
CACA_CAID_PU_LHOProviderBulletin.pdfAnthem Blue Cross Medi-Cal Health Plan Launches LiveHealth Online11/30/2018 12:00 AM2018CaliforniaApproved
ININ_CAID_NotifJuly2018.pdfJuly 2018 Medical Policies and Clinical Utilization Management Guidelines Update11/30/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_UrgentTransportationRequests.pdfConfirming urgent care requests for transportation 12/3/2018 12:00 AM2018IndianaApproved
KYKY_CAID_PU_InterferonBetaDrug.pdfPrior authorization requirements for Interferon beta-1a12/10/2018 12:00 AM2018KentuckyApproved
KYKY_CAID_PU_ProviderNotificationNUKY.pdfServices requiring prior authorization12/10/2018 12:00 AM2018KentuckyApproved
ININ_CAID_PU_LARCReminder.pdfLARC Reminder11/28/2018 12:00 AM2018IndianaApproved
ININ_CAID_PU_InterferonBetaDrug.pdfPrior authorization requirements for Interferon beta-1a12/10/2018 12:00 AM2018IndianaApproved
NVNV_CAID_PU_InterferonBetaDrug.pdfPrior authorization requirements for Interferon beta-1a12/10/2018 12:00 AM2018NevadaApproved
ININ_CAID_PU_DecemberNUEDI.pdfElectronic data interchange gateway update11/28/2018 12:00 AM2018IndianaApproved
NVNV_CAID_PU_MPTACNotif.pdfSeptember 2018 Medical Policies and Clinical Utilization Management Guidelines Update12/11/2018 12:00 AM2018NevadaApproved
ININ_CAID_PU_DMERentalList.pdfDME Rental List update12/11/2018 12:00 AM2018IndianaApproved
CACA_CAID_PU_Sep 2018MPTACNotif.pdfSeptember 2018 Medical Policies and Clinical Utilization Management Guidelines update12/11/2018 12:00 AM2018CaliforniaApproved
VAVA_CAID_PU_Sep 2018MPTACNotif.pdfSeptember 2018 Medical Policies and Clinical Utilization Management Guidelines update12/11/2018 12:00 AM2018VirginiaApproved
WIWI_CAID_PU_Sep 2018MPTACNotif.pdfSeptember 2018 Medical Policies and Clinical Utilization Management Guidelines update12/11/2018 12:00 AM2018WisconsinApproved
KYKY_CAID_PU_InjectionEmicizumab.pdfPrior authorization requirements for Emicizumab-kxwh injection12/10/2018 12:00 AM2018KentuckyApproved
CACA_CAID_CUMGWebPosting.pdfSeptember 2018 Clinical Utilization Management (UM) Guidelines12/12/2018 12:00 AM2018CaliforniaApproved
KYKY_CAID_DMEIncontinenceSupplies.pdfDurable medical equipment incontinence supplies benefit limit update2018KentuckyApproved
WIWI_CAID_EXPRESS_PersonalCareWorkerPowerPoint.pdfPersonal Care Worker Training 2018WisconsinApproved
NVNV_CAID_SAMHSAClinicalGuidance.pdfClinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants12/17/2018 12:00 AM2018NevadaApproved
WIWI_CAID_AIMRehabAnnouncement.pdfTransition of Outpatient Rehabilitation Utilization Management program2018WisconsinApproved
ININ_CAID_SAMHSAClinicalGuidanceforSUD.pdfClinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants12/20/2018 12:00 AM2018IndianaApproved
ININ_CAID_SUDClaimsInstructionsBulletin.pdfSubstance use disorder instructions: residential services12/20/2018 12:00 AM2018IndianaApproved
NVNV_CAID_SubcutaneousImplantableDefibrillator.pdfPrior authorization requirements for Subcutaneous Implantable Defibrillator system2018NevadaApproved
NVNV_CAID_Sublocade.pdfPrior authorization requirements for Sublocade2018NevadaApproved
KYKY_CAID_PU_MedicareCrossoverClaims.pdfMedicare crossover claims for federally qualified health centers and rural health clinics2019KentuckyApproved
ININ_CAID_PU_AIMMSKNotificationUpdate.pdf Expansion of Services with AIM Specialty Health for Musculoskeletal services 1/3/2019 12:00 AM2018IndianaApproved
ININ_CAID_Sept2018CUMG.pdfSeptember 2018 Clinical Utilization Management Guidelines1/15/2019 12:00 AM2019IndianaApproved
ININ_CAID_Sept2018MPTACNotification.pdfSeptember 2018 Medical Policies and Clinical Utilization Management Guidelines Update1/11/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_AIMRehabProgram.pdfAnthem Blue Cross and Blue Shield is expanding their partnership with AIM Specialty Health2/6/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_MPTACNotif3Q18.pdfJuly 2018 Medical Policies and Clinical Utilization Management Guidelines Update2019KentuckyApproved
CACA_CAID_PU_DiabetesCodingSpotlight.pdfDiabetes Coding Spotlight1/15/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_DiabetesCodingSpotlight.pdfDiabetes Coding Spotlight2018Approved
NYNY_CAID_PU_DiabetesCodingSpotlight.pdfDiabetes Coding Spotlight2018Approved
ININ_CAID_4thQuarterUpdates.pdfFourth quarter updates1/15/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_3Q18FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20191/16/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_3Q18FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20191/16/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_3Q18FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20191/16/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_3Q18FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20191/16/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_3Q18FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20191/16/2019 12:00 AM2019VirginiaApproved
ININ_CAID_Modifier25ArticleUpdate.pdfReimbursement Policy Update: Modifier 251/9/2019 12:00 AM2019IndianaApproved
CACA_CAID_EXPRESSVoluntarydrugsteerage.pdfMMP - New specialty Medicare Part B device Voluntary Steerage Program1/28/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_EXPRESSPharmacyMedicaidURL.pdfIntroducing a new clinical criteria web page for injectable, infused or implanted drugs covered under the medical benefit1/30/2019 12:00 AM2019KentuckyApproved
WIWI_CAID_PU_NICUPTSD.pdfNICU post-traumatic stress disorder program2019WisconsinApproved
ININ_CAID_PU_Aspirepalliativecareprogram.pdfAspire Health provides palliative care for Medicaid members1/31/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_Aspirepalliativecareprogram.pdfAspire Health provides palliative care for Medicaid members 2019KentuckyApproved
KYKY_CAID_PU_DecemberNUEDI.pdfElectronic data interchange gateway update2019KentuckyApproved
KYKY_CAID_PU_DiabetesCodingSpotlight.pdfDiabetes Coding Spotlight2019KentuckyApproved
CACA_CAID_PU_HealthInformationFormDataAvaility.pdfNew Member Health Assessment Data Now Available on Availity in Provider Online Reporting Application2/1/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_WorkersCompBulletin.pdfWorker’s Compensation Reporting Update2/5/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_NotiftransplantCriteria.pdfTransplant criteria notification1/6/2019 12:00 AM2019KentuckyApproved
CACA_CAID_PU_NICUPTSD.pdfNICU post-traumatic stress disorder program3/6/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_FacilityTakeHomeDrugsRP.pdfFacility Take-Home Drugs Reimbursement Policy Update2/13/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_PRIORITYKYHEALTHWebinarInvite.pdf KY HEALTH Webinar Invite2019KentuckyApproved
CACA_CAID_PU_PandTCommitteeWebPosting.pdfClinical Criteria updates2/15/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_PandTCommitteeWebPosting.pdfClinical Criteria updates2/15/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_PandTCommitteeWebPosting.pdfClinical Criteria updates2/19/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_PandTCommitteeWebPosting.pdfClinical Criteria updates2/15/2019 12:00 AM2019WisconsinApproved
NVNV_CAID_PU_Wave600Invite.pdfFebruary and March Availity Claim Payment Disputes Webinar Trainings2019NevadaApproved
ININ_CAID_PU_Homehospicebillingclarification.pdfHome hospice billing clarification2/20/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_WAVE600UpdatedNetworkArticle.pdfElectronic claim payment reconsideration2019NevadaApproved
ININ_CAID_PU_InpatientRehabbillingclarification.pdfInpatient rehabilitation billing clarification2/20/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_AmbulanceUpdateBulletin.pdfChanges in prior authorization for ambulance transportation2/20/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_EXPRESSApptAccessSurvey.pdfAppointment Access Standards2/28/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_Correction-CervicalLengthMeasurementTransvaginalUltrasound.pdfCorrection: Cervical length measurement by transvaginal ultrasound2/28/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_Correction-CervicalLengthTransvaginalUltrasound.pdfCorrection: Cervical length measurement by transvaginal ultrasound2019KentuckyApproved
VAVA_CAID_PU_Correction-CervicalLengthTransvaginalUltrasound.pdfCorrection: Cervical length measurement by transvaginal ultrasound2019VirginiaApproved
KYKY_CAID_ClinicalCriteriaUpdates.pdfClinical Criteria Updates - Posted 3/6/20192019KentuckyApproved
NVNV_CAID_ClinicalCriteriaUpdates.pdfClinical Criteria Updates - Posted 3/6/20192019NevadaApproved
NVNV_CAID_PU_CervicalLengthMeasurement.pdfCorrection: Cervical length measurement by transvaginal ultrasound2019NevadaApproved
CACA_CAID_PU_PTACNotif.pdfNovember 2018 Medical Policies and Clinical Utilization Management Guidelines update3/6/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_NovMPTACNotif.pdfNovember 2018 Medical Policies and Clinical Utilization Management Guidelines update3/6/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_NovMPTACNotif.pdfNovember 2018 Medical Policies and Clinical Utilization Management Guidelines update3/6/2019 12:00 AM2019WisconsinApproved
VAVA_CAID_PU_PrenatalUltrasoundICD10Update_March2019.pdfPrenatal Ultrasound Policy/ICD-10 Update 2019VirginiaApproved
WIWI_CAID_PU_PrenatalUltrasoundICD10Update_March2019.pdfPrenatal Ultrasound Policy/ICD-10 Update 2019WisconsinApproved
KYKY_CAID_PU_PrenatalUltrasoundICD10Update_March2019.pdfPrenatal Ultrasound Policy/ICD-10 Update 2019KentuckyApproved
ININ_CAID_PU_EXPRESSCommitteeWeb.pdfClinical Criteria updates 3/8/2019 12:00 AM2019IndianaApproved
VAVA_CAID_PU_EXPRESSPTClinicalCriteriaWP030819.pdfClinical Criteria updates - Posted 3/8/20192019VirginiaApproved
WIWI_CAID_PU_EXPRESSPTClinicalCriteriaWP030819.pdfClinical Criteria updates - Posted 3/8/20192019WisconsinApproved
KYKY_CAID_PU_MedicalNecessityReviewforAppropriateLevelofCare.pdfMedical necessity review for appropriate level of care2019KentuckyApproved
NVNV_CAID_PU_Physicalandoccupationaltherapyredirection.pdfPhysical and occupational therapy redirection2019NevadaApproved
KYKY_CAID_PU_PandTCommitteeMeetingDates_2019.pdfPharmacy and Therapeutics Advisory Committee 2019 Meeting Dates2019KentuckyApproved
CACA_CAID_PU_EXPRESSProvRemitUpdate.pdfProvider Remit and Provider Payment Updates3/12/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_PandTClinicalCriteria.pdfClinical Criteria Updates3/13/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_NoncoveredCodeAudit.pdfDenial of claims billed with noncovered codes2019KentuckyApproved
NVNV_CAID_PU_PRIORITYVoyagerProviderUpdate.pdfPharmacy benefit manager change to IngenioRx5/1/2019 12:00 AM2019NevadaApproved
CACA_CAID_PU_FormularyUpdate_3-19-19.pdfQuarterly pharmacy formulary change notice effective May 1, 20193/18/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_FormularyChangeNotice_3-18-19.pdfQuarterly pharmacy formulary change notice effective May 1, 20192019KentuckyApproved
ININ_CAID_PU_ChangeHospreqFacandbill.pdfChange in hospice requirements and billing updates4/2/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_4Q18FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective May 1,20192019NevadaApproved
ININ_CAID_PU_GatewaytoWork.pdfGateway to Work program has launched3/21/2019 12:00 AM2019IndianaApproved
CACA_MMP_PU_PAforDMERepairPortableOxygenConcentrator.pdfMMP Prior authorization requirements for DME repair and portable oxygen concentrator3/25/2019 12:00 AM2019California, CAMMPApproved
NVNV_CAID_PU_Nov2018MedPoliciesCUMGUpdate.pdfNovember 2018 Medical Policies and Clinical Utilization Management Guidelines Update2019NevadaApproved
ININ_CologuardCoveredBulletin.pdfCologuard is now covered3/26/2019 12:00 AM2019IndianaApproved
ININ_CAID_PreventPreeclampsiaPrenatalAspirin.pdfHelp prevent preeclampsia with prenatal aspirin3/26/2019 12:00 AM2019IndianaApproved
ININ_CAID_NovMPTACNotification.pdfNovember 2018 Medical Policies and Clinical Utilization Management Guidelines Update3/26/2019 12:00 AM2019IndianaApproved
WIWI_CAID_PU_CPTCategoryII.pdfCPT Category II code reimbursements2019WisconsinApproved
KYKY_CAID_EXPRESSKentuckyHEALTH.PDFKY HEALTH Update3/29/2019 12:00 AM2019KentuckyApproved
KYKY_CAID_HEALTHProgramUpdateFAQ.PDFKY HEALTH FAQ3/29/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_AuthChangesICTCIandCS.pdfAuthorization changes for procedure codes2019VirginiaApproved
KYKY_CAID_PU_PARequirementsForDrugCodes.pdfPrior authorization requirements for drug codes2019KentuckyApproved
KYKY_CAID_PU_SubcutaneousImplantableDefibrillator.pdfPrior authorization requirements for Subcutaneous Implantable Defibrillator system2019KentuckyApproved
CACA_CAID_WAVEEDIGateway.pdfLatest updates to Electronic Data Interchange Gateway migration4/1/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_WAVEEDIGateway.pdfLatest updates to Electronic Data Interchange Gateway migration4/1/2019 12:00 AM2019NevadaApproved
WIWI_CAID_WAVEEDIGateway.pdfLatest updates to Electronic Data Interchange Gateway migration4/1/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_WAVE600ArticleUpdate.pdfElectronic claim payment reconsideration5/2/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_WAVEInvite.pdfWebinar Invite: Availity Claim Payment Disputes4/1/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_QuarterlyPharmacyNotice_April2019.pdfQuarterly pharmacy formulary change notice effective May 1, 20195/1/2019 12:00 AM2019IndianaApproved
VAVA_CAID_PU_QuarterlyFormularyChangeNotice_May2019.pdfQuarterly pharmacy formulary change notice effective May 1, 20192019VirginiaApproved
KYKY_CAID_BuprenorphinePAPolicy.pdfBuprenorphine prior authorization2019KentuckyApproved
CACA_CAID_PU_EXPRESSMedicalStepTherapyProviderRetractionNotice.pdfNew Specialty Pharmacy Medical Step Therapy Requirements4/9/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_EXPRESSMedicalStepTherapyProviderRetractionNotice.pdfNew Specialty Pharmacy Medical Step Therapy Requirements4/9/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_EXPRESSMedicalStepTherapyProviderRetractionNotice.pdfNew Specialty Pharmacy Medical Step Therapy Requirements4/9/2019 12:00 AM2019NevadaApproved
KYKY_CAID_PU_NewDrugCodes.pdfChanges to prior authorization requirements for drug codes effective June 1, 20192019KentuckyApproved
NVNV_CAID_PU_EvalandMgmntModifier25.pdfUpdate: evaluation and management with Modifier 252019NevadaApproved
ININ_CAID_PU_MedicalSTProviderRetractionNotice.pdfNew Specialty Pharmacy Medical Step Therapy Requirements4/17/2019 12:00 AM2019IndianaApproved
WIWI_CAID_PU_2019UMAffirmativeStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions2019WisconsinApproved
CACA_CAID_PU_2019UMAffirmativeStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions4/19/2019 12:00 AM2019CaliforniaApproved
CACA_MMP_PU_2019UMAffirmationStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions4/19/2019 12:00 AM2019CAMMPApproved
ININ_CAID_PU_2019UMAffirmativeStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions4/19/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_2019UMAffirmativeStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions4/19/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU2019UMAffirmativeStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions4/19/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_2019UMAffirmativeStatement.pdf2019 Utilization Management Affirmative Statement concerning utilization management decisions2019VirginiaApproved
KYKY_CAID_PU_4Q18FormularyChangeNoticePart2.pdfQuarterly pharmacy formulary change notice part II effective May 1, 20192019KentuckyApproved
CACA_CAID_SubmittingMAcorrectedclaims.pdfMMP Submitting corrected claims4/29/2019 12:00 AM2019CaliforniaApproved
CACA_MMP_PartialHospitalizationProgram.pdfMMP Partial hospitalization services4/29/2019 12:00 AM2019California, CAMMPApproved
ININ_CAID_MSKCodePriorAuthorizationUpdate.pdfPrior authorization requirement update5/1/2019 12:00 AM2019IndianaApproved
WIWI_CAID_PU_MSKCodePriorAuthorizationUpdate.pdfPrior authorization requirement update4/29/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_4Q18FormularyChangeNoticePart2.PDFQuarterly pharmacy formulary change notice part II effective May 1, 20195/1/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_4Q18FormularyChangeNoticePart2.PDFQuarterly pharmacy formulary change notice part II effective May 1, 20195/1/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_4Q18FormularyChangeNoticePart2.pdfQuarterly pharmacy formulary change notice part II effective May 1, 20192019NevadaApproved
CACA_CAID_PU_OptumMRAProvNewsletter.pdfMMP Medical records request for risk adjustment5/1/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_ABAUpdateBulletin.PDFApplied behavior analysis services5/1/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_HistoricDrugCriteria.pdfMedical Drug Criteria Updates5/1/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_NovMPTACNotif.pdfNovember 2018 Medical Policies and Clinical Utilization Management Guidelines Update2019KentuckyApproved
ININ_CAID_PU_ChangeInHospiceReqandBillingUpdate.PDFChange in hospice requirements and billing updates5/1/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_BillingUpdate.pdfFirst quarter 2019 billing updates5/3/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_FastTrackPA.pdfPrior authorization process for Fast Track prepayment5/7/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_BHReviewOnAvailityBulletin.pdfBehavioral Health Review on the Availity Portal5/7/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_Encounterupdate.pdfEncounter Data Submission Requirements Update5/13/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_BHFacilityInpatientDetoxDualDiagnosisReimbursement.pdfBehavioral health facility inpatient detox dual diagnosis reimbursement2019NevadaApproved
KYKY_CAID_PU_MedicaidEnrollmentDenial.PDFMedicaid Enrollment Denial2019KentuckyApproved
KYKY_CAID_PU_NoticeOfChangeRegardingVentilatorUse.pdfNotification of change regarding noninvasive ventilator use2019KentuckyApproved
KYKY_CAID_PU_PRIORITYNoticeChangeHoursObservationStatus.pdfNotification of change in hours of observation status2019KentuckyApproved
KYKY_CAID_PU_ProviderFileLoadError.pdf Provider File Load Error5/13/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_NVFrontEndEditChanges.pdfNevada Front End Changes2019NevadaApproved
NVNV_CAID_PU_HowToContactIngenioRX0519.pdfHow to contact IngenioRx Specialty Pharmacy beginning May 1, 20192019NevadaApproved
KYKY_CAID_PU_HealthCrowdProviderEducationFlyer.pdfHealth Crowd Provider Education2019KentuckyApproved
VAVA_CAID_PU_EXPRESSCCCEDCDWaiverChgs.pdfElderly or Disabled with Consumer Direction Waiver updates5/16/2019 12:00 AM2019VirginiaApproved
CACA_CAID_ProviderRemitPaymentDisbursementUpdate.pdfDate Delay - Provider Remit and Payment Disbursement Process Update6/3/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_UMAffirmationStatement.pdfMMP 2019 Utilization Management Affirmative Statement concerning utilization management decisions4/19/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_EXPRESWAVE600PrvdrComm.pdfElectronic claim payment appeal2019KentuckyApproved
KYKY_CAID_PU_SUD1115WaiverUpdate.pdfSubstance Use Disorder (SUD) 1115 Waiver Update6/5/2019 12:00 AM2019KentuckyApproved
WIWI_CAID_PU_AvailityClaimPaymentDisputesWebinarTraining.pdfAvaility claim payment disputes webinar training6/6/2019 12:00 AM2019WisconsinApproved
WIWI_CAID_PU_ElectronicClaimPaymentReconsideration.pdfElectronic claim payment reconsideration6/6/2019 12:00 AM2019WisconsinApproved
CACA_CAID_ClinicalValidationReview.pdfMMP Prepayment clinical validation review process6/7/2019 12:00 AM2019California, CAMMPApproved
KYKY_CAID_ClinicalValidationReview.pdfPrepayment clinical validation review process6/7/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_ClinicalValidationReview.pdfPrepayment clinical validation review process6/7/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_ClinicalValidationReview.pdfPrepayment clinical validation review process6/7/2019 12:00 AM2019WisconsinApproved
CACA_CAID_UnspecifiedDXCodeUpdate.pdfUnspecified diagnosis code update6/5/2019 12:00 AM2019CaliforniaApproved
CACA_MMP_UnspecifiedDXCodeUpdate.pdfMMP Unspecified diagnosis code update6/5/2019 12:00 AM2019California, CAMMPApproved
WIWI_CAID_UnspecifiedDXCodeUpdate.pdfUnspecified diagnosis code update6/5/2019 12:00 AM2019WisconsinApproved
VAVA_CAID_PU_UnspecifiedDXCodeUpdate.pdfUnspecified DX Code Update2019VirginiaApproved
VAVA_CAID_PU_WAVE600ProviderNotice.pdfElectronic claim payment reconsideration6/10/2019 12:00 AM2019VirginiaApproved
VAVA_CAID_PU_WAVE600WebinarInvite.pdfAvaility claim payment disputes webinar training6/10/2019 12:00 AM2019VirginiaApproved
VAVA_CAID_PU_1Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective July 1, 20192019VirginiaApproved
NVNV_CAID_PU_UnspecifiedDXCodeUpdate.pdfUnspecified diagnosis code update6/14/2019 12:00 AM2019NevadaApproved
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