Skip navigation
Login
Contact
  • The Anthem
    Network
  • Prior Authorization
    & Claims
  • Member Eligibility
    & Benefits
  • Provider
    Support

Provider Support Education & Resources

Communications & Updates

Network Updates and Newsletters

2019
  • Current Issue
2018
  • Network Update - current edition
  • June 2018 Network Update
  • April 2018 Network Update
  • February 2018 Network Update
2017
  • December 2017 Network Update
  • October 2017 Network Update
  • August 2017 Network Update
  • June 2017 Network Update
  • April 2017 Network Update
  • February 2017 Network Update

Communications and Updates

provider-bulletins.js

 

Page Last Updated: 3/13/2020

 
Having problems accessing this content? Please call your provider relation representative or the provider help line applicable to the member’s health plan.
©2020 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Waste, Fraud, & Abuse| Terms of Use| Privacy Policies
Download Adobe Reader

 ‭(Hidden)‬ Provider Updates
Name (for use in forms)TitleDateProvider-Update-YearMarketApproval Status
KYKY_CAID_PU_AuthorizationNotification_July2014.pdfAuthorization Notification July 20142014KentuckyApproved
VAVA_CAID_RecontractingPharmacyNetwork.pdfNew Pharmacy Network2015VirginiaApproved
KYKY_CAID_PharmacyFormularyChangeNotice.pdfPharmacy Formulary Change Notice2014KentuckyApproved
KYKY_CAID_NameChangeAnnouncement.pdfAnthem Medicaid Name Change Announcement2014KentuckyApproved
KYKY_CAID_PU_MedicaidOpenEnrollment.pdfOpen Enrollment2014KentuckyApproved
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_2015AvailityFAQs.pdfAvaility FAQs2015KentuckyApproved
WIWI_CAID_PU_Dec2014ReimbPolicyBulletin.pdfDecember 2014 Reimbursement Policy Bulletin​2014WisconsinApproved
KYKY_CAID_PU_UpdatedConfidentialityofRecordsPolicy.pdfUpdated Confidentiality of Records 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_CMHC_Billing_Guidance.pdfCMHC Medicaid Billing Guidance Second Edition2015KentuckyApproved
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
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
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
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
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
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_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
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
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
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
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_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_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
CACA_CAID_PU_2016MedicalPoliciesNotificationQ2.pdfQ2 Medical policies and Clinical Utilization Management (UM) Guidelines8/31/2016 12:00 AM2016CaliforniaApproved
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
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
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_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_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
VAVA_CAID_PU_IsotaxIxempraDoxilToriselInflectra.pdfIstodax, Ixempra, Doxil, Torisel, Inflectra2016VirginiaApproved
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
CACA_CAID_PU_2017QuarterlyPharmacyFormularyChange.pdfQuarterly pharmacy formulary change notice effective March 1, 20172/1/2017 12:00 AM2017CaliforniaApproved
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
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
KYKY_CAID_HealthyRewardsFlier.pdfHealthy Rewards Program2020KentuckyApproved
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
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
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_MedicalPolicyUpdateNotification_2017.pdfMedical Policy Update Notification2017KentuckyApproved
WIWI_CAID_PU_PADrugsusedintheoutpatienthospitalsetting.pdfPrior authorization of drugs used in the outpatient hospital setting2017WisconsinApproved
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
WIWI_CAID_PU_Patient360AvailityAccess.pdfBeginning in April: Access Patient360 directly through the Availity Web Portal2017WisconsinApproved
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.pdfMMP Modifier FX and Reimbursement Policy Update6/7/2017 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
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
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
VAVA_CAID_PU_LeadTestingFAQ.pdfLead Testing FAQ2017VirginiaApproved
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
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
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
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_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
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_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
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
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_CCC_PU_UMAffirmativeStatement.pdfAnthem CCC Plus 2018 Utilization Management Affirmative Statement2018Virginia, VA MMPApproved
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
ININ_CAID_PU_First8visitsofTherapyProviderBulletin.pdfFirst 8 Visits of Therapy Provider Bulletin2/27/2018 12:00 AM2018IndianaApproved
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
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
CACA_CAID_HomeHealthBillingBulletin.pdfHome Health Nursing Visits Updates: Effective2/8/2018 12:00 AM2018CaliforniaApproved
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_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
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
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
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
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
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
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
VAVA_CAID_Modifier25ArticleUpdate.pdfPolicy Update - Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service (Policy 06-003, eff 04/01/2019)2019VirginiaApproved
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
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
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_2020.pdfPharmacy and Therapeutics Advisory Committee 2020 Meeting Dates2020KentuckyApproved
CACA_CAID_PU_EXPRESSProvRemitUpdate.pdfProvider Remit and Provider Payment Updates7/2/2019 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
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
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 Update6/20/2019 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.pdfPrepayment 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 August 1, 20196/28/2019 12:00 AM2019VirginiaApproved
NVNV_CAID_PU_UnspecifiedDXCodeUpdate.pdfUnspecified diagnosis code update6/14/2019 12:00 AM2019NevadaApproved
CACA_CAID_PU_MPTAC_Jan2019.pdfJanuary 2019 Medical Policies and Clinical Utilization Management Guidelines Update6/14/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_MPTAC_Jan2019.pdfJanuary 2019 Medical Policies and Clinical Utilization Management Guidelines Update6/14/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_MPTAC_Jan2019.pdfJanuary 2019 Medical Policies and Clinical Utilization Management Guidelines Update6/14/2019 12:00 AM2019WisconsinApproved
ININ_CAID_PU_AccessToPhysicalHealth.pdfAccess to physical health6/14/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_ClinicalValidationReview.pdfPrepayment clinical validation review process6/20/2019 12:00 AM2019NevadaApproved
ININ_CAID_PU_InpatientReadmissionPolicyBillingAlert.pdfInpatient readmission policy and billing guidance6/18/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_AccessToBehavioralHealth.pdfAccess to Care - Behavioral Health Bulletin6/20/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_FacilityReimbursementEED.pdfFacility reimbursement for early elective deliveries2019NevadaApproved
WIWI_CAID_PU_FacilityReimbursementEED.pdfFacility reimbursement for early elective deliveries2019WisconsinApproved
ININ_CAID_PU_ElectronicClaimPaymentReconsideration.pdfElectronic claim payment reconsideration6/20/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_InpatientLessThan24hrs.pdfInpatient Stays Less Than 24 Hours bulletin6/24/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_MPTACBulletinNotificationKY.pdfJanuary 2019 Medical Policies and Clinical Utilization Management Guidelines Update6/24/2019 12:00 AM2019KentuckyApproved
CACA_CAID_PU_ClinicalCriteriaWebQ2.pdfClinical Criteria Web Posting Q2 20196/25/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_FacilityEED.pdfFacility reimbursement for early elective deliveries6/19/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_MPTAC_Jan2019update.pdfJanuary 2019 Medical Policies and Clinical Utilization Management Guidelines Update6/27/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_DMERentalClarificationUpdate.pdfDME Rental Clarification Bulletin6/28/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_EXPRESSCAPerinatalDepressionScreening.pdfScreening for perinatal and postpartum depression6/28/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_PAreqHyperbaric.pdfPrior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy6/28/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_PAreqHyperbaric.pdfPrior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy6/28/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_PAreqHyperbaric.pdfPrior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy6/28/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_1Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective August 1, 20196/28/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_1Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective August 1, 20196/28/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_1Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective August 1, 20196/28/2019 12:00 AM2019NevadaApproved
ININ_CAID_PU_PAreqHyperbaric.pdfPrior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy7/2/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_MedlineBreastPumpNotification.pdfMedline Breast Pump Notification Bulletin6/27/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_1Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective August 1, 20197/9/2019 12:00 AM2019IndianaApproved
ININ_CAID_PUConcurrentBillingBulletin.pdfBilling of applied behavioral analysis and speech, occupational and physical therapies7/8/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_DenialUpdateBulletin.pdfG18 denial code update7/10/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_ClinicalCriteria2Q19.pdfClinical Criteria Web Posting Q2 20197/10/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_ClinicalCriteria2Q19.pdfClinical Criteria Web Posting Q2 20197/10/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_ClinicalCriteria2Q19.pdfClinical Criteria Web Posting Q2 20197/10/2019 12:00 AM2019WisconsinApproved
NVNV_CAID_PU_EXPRESSProviderPaymentSchedule.pdfProvider payment schedule updates7/15/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_Aug2019NewsLetter.pdfProvider Satisfaction Survey information2019VirginiaApproved
CACA_CAID_Admission.pdfPayment of Emergency Services7/17/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_UpdateKYMedicaidDMEFeeSchedulereim.pdfUpdate to Kentucky Medicaid durable medical equipment fee schedule reimbursement7/15/2019 12:00 AM2019KentuckyApproved
ININ_CAID_PU_UnspecifiedDXCode.pdfUnspecified DX Code Update7/16/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_ProviderSatisfactionSurvey.pdf2019 Provider Satisfaction Survey: We need your help! 7/15/2019 12:00 AM2019KentuckyApproved
ININ_CAID_PU_ClinicalCriteria2Q19.pdfClinical Criteria Web Posting Q2 20197/17/2019 12:00 AM2019IndianaApproved
KYKY_CAID_RP_UnspecifiedDXCodeUpdate.pdfUnspecified diagnosis code update7/23/2019 12:00 AM2019KentuckyApproved
CACA_CAID_PU_ClinicalCriteria1Q19.pdfClinical Criteria Web Posting Q1 20197/25/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_ClinicalCriteria1Q19.pdfClinical Criteria Web Posting Q1 20197/25/2019 12:00 AM2019VirginiaApproved
KYKY_CAID_PU_EXPRESSClinicalCriteriaWebPostQ22019.pdfClinical Criteria Web Posting Q2 20192019KentuckyApproved
VAVA_CAID_PU_EvaluationManagementServicesOvercodedServices.pdfEvaluation and management services -over-coded services7/30/2019 12:00 AM2019VirginiaApproved
NVNV_CAID_PU_ClinicalCriteriaWeb.pdf Clinical Criteria Web Posting Q1 20198/5/2019 12:00 AM2019NevadaApproved
CACA_CAID_PU_CustomizationforIPCancerTherapy.pdfCustomization for IP Cancer Therapy8/6/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_CustomizationforIPCancerTherapy.pdfCustomization for IP Cancer Therapy8/6/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_CustomizationforIPCancerTherapy.pdfCustomization for IP Cancer Therapy8/6/2019 12:00 AM2019WisconsinApproved
ININ_CAID_PU_CLIAProviderNotification.pdfClinical Laboratory Improvement Amendments8/7/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_CLIAProviderNotification.pdfClinical Laboratory Improvement Amendments8/7/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_CLIAProviderNotification.pdfClinical Laboratory Improvement Amendments8/7/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_CLIAProviderNotification.pdfClinical Laboratory Improvement Amendments8/7/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_CLIAProviderNotification.pdfClinical Laboratory Improvement Amendments8/7/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_SemiAnnualCostOfCareReview.pdfPrior authorization changes8/7/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_SemiAnnualCostOfCareReview.pdfPrior authorization changes8/7/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_SemiAnnualCostOfCareReview.pdfPrior authorization changes8/7/2019 12:00 AM2019WisconsinApproved
ININ_CAID_PU_SemiAnnualCostofCareReview.pdfPrior authorization changes8/7/2019 12:00 AM2019IndianaApproved
WIWI_CAID_PU_ClinicalCriteria1Q19.pdfClinical Criteria Web Posting Q1 20198/8/2019 12:00 AM2019WisconsinApproved
VAVA_CAID_PU_TaxonomyCodes.pdfTaxonomy codes8/9/2019 12:00 AM2019VirginiaApproved
CACA_CAID_PU_CCRTConfigurationPAChanges.pdfPrior authorization requirements for Global March MPTAC CCRT Configuration8/9/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_InterQual2019update.pdfInterQual 2019 update8/14/2019 12:00 AM2019KentuckyApproved
KYKY_CAID_PU_ProviderPaymentSchedule.pdfProvider payment schedule updates8/14/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_MedicalNecessityReviewAppropriateLevelCare.pdfMedical necessity review for appropriate level of care8/15/2019 12:00 AM2019VirginiaApproved
CACA_CAID_PU_RegulatoryUpdates.pdfRegulatory updates8/15/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_EXPRESSWavePartDIngenioRx.pdfMMP Pharmacy benefit manager change to IngenioRx8/19/2019 12:00 AM2019California, CAMMPApproved
CACA_CAID_PU_MedicareCoCRules.pdfMMP Q2 2019 Changes to PA Requirements8/19/2019 12:00 AM2019California, CAMMPApproved
ININ_CAID_PharmacyBenefitManagerIngenioRX.pdfPharmacy benefit manager change to IngenioRx8/19/2019 12:00 AM2019IndianaApproved
VAVA_CAID_PharmacyBenefitManagerIngenioRX.pdfPharmacy benefit manager change to IngenioRx8/19/2019 12:00 AM2019VirginiaApproved
KYKY_CAID_PharmacyBenefitManagerIngenioRX.pdfPharmacy benefit manager change to IngenioRx8/19/2019 12:00 AM2019KentuckyApproved
CACA_CAID_PharmacyBenefitManagerIngenioRX.pdfPharmacy benefit manager change to IngenioRx effective October 1, 201912/31/2019 12:00 AM2019CaliforniaApproved
WIWI_CAID_PU_PediatricTherapyUpdates.pdfPediatric therapy update8/20/2019 12:00 AM2019WisconsinApproved
KYKY_CAID_PU_ClinicalCriteriaWebQ12019.pdfClinical Criteria web posting Q1 20198/20/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_MedroxyprogesteroneInjectFormularyChange.pdfMedroxyprogesterone Injectives Formulary Change Notice8/23/2019 12:00 AM2019VirginiaApproved
NVNV_CAID_PU_MPTACBulletinNotifJan2019.pdfJanuary 2019 Medical Policies and Clinical Utilization Management Guidelines Update RELEVANT URL2019NevadaApproved
CACA_CAID_PU_19June2019MPTACCARE_MMP.pdfMedical Policies and Clinical Utilization Management Guidelines update8/28/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_MMPAllClinicalCriteriaUpdate.pdfMMP Clinical Criteria Updates8/29/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_ClinicalCriteriaQ1Web.pdfMMP Clinical Criteria Web Posting Q1 20198/30/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_ClinicalCriteriaQ2.pdfMMP Clinical Criteria Web Posting Q2 20199/25/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_MPTAC_Aug2019.pdfMedical Policies and Clinical Utilization Management Guidelines9/6/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_DrugscreenPAform.pdfUpdate to Prior Authorizations1/1/2017 12:00 AM2017IndianaApproved
KYKY_CAID_PU_AvailityMaternityModule.pdfNew pregnancy notification process using the Availity Portal Benefit Look-Up Tool2019KentuckyApproved
NVNV_CAID_PU_AvailityMaternityModule.pdfNew pregnancy notification process using the Availity Portal Benefit Look-Up Tool2019NevadaApproved
VAVA_CAID_EVVProviderBulletin.pdfElectronic Visit Verification (EVV) Provider Bulletin9/11/2019 12:00 AM2019VirginiaApproved
CACA_CAID_PU_MPTAC_Mar2019.pdfMarch 2019 Medical Policies and Clinical Utilization Management Guidelines Update9/11/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_ClinicalCriteriaJuly2019.pdfClinical Criteria Web Posting July 20199/11/2019 12:00 AM2019VirginiaApproved
VAVA_PU_CAID_MPTAC_Mar2019.pdfMarch 2019 Medical Policies and Clinical Utilization Management Guidelines Update9/13/2019 12:00 AM2019VirginiaApproved
WIWI_PU_CAID_MPTAC_Mar2019.pdfMarch 2019 Medical Policies and Clinical Utilization Management Guidelines Update9/13/2019 12:00 AM2019WisconsinApproved
VAVA_CAID_PU_MPTAC_Jun2019.pdfJune 2019 Medical Policies and Clinical Utilization Management Guidelines Update9/13/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_MPTAC_Jun2019update.pdfJune 2019 Medical Policies and Clinical Utilization Management Guidelines Update9/13/2019 12:00 AM2019WisconsinApproved
NVNV_CAID_Mar2019CUMGupdates.pdfMarch 2019 Medical Policies and CUMG Updates2019NevadaApproved
NVNV_CAID_BehavioralHealthTherapySessionLimitations.pdfBehavioral health therapy session limitations2019NevadaApproved
NVNV_CAID_CCRTConfigurationPAChgsBlue.pdfPrior authorization requirements changes effective November 1, 20192019NevadaApproved
NVNV_CAID_PU_SemiAnnualCostofCareReview.pdfPrior authorization changes2019NevadaApproved
CACA_CAID_PU_ClinicalCriteriaJul19.pdfClinical Criteria Web Posting July 20199/16/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_ClinicalCriteriaJul19.pdfClinical Criteria Web Posting July 20199/16/2019 12:00 AM2019NevadaApproved
WIWI_CAID_PU_ClinicalCriteriaJul19.pdfClinical Criteria Web Posting July 20199/16/2019 12:00 AM2019WisconsinApproved
NVNV_CAID_PU_PAreqHyperbaric02.pdfPrior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy9/24/2019 12:00 AM2019NevadaApproved
CACA_CAID_PU_PLUTOProviderBulletin.pdfPrecertification lookup tool (PLUTO) now available9/16/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_DrugScreenTesting.pdfDrug Screen Testing Update9/16/2019 12:00 AM2019NevadaApproved
NVNV_CAID_PU_CustomizationIPCancer.pdfMCG Care Guidelines update and customizations9/16/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_PrenatalServiceThirdPartyLiabilityChange.pdfPrenatal service third-party liability change9/17/2019 12:00 AM2019VirginiaApproved
CACA_CAID_PU_DrugScreenTesting110119.PDFDrug Screen Testing Update9/10/2019 12:00 AM2019CaliforniaApproved
CACA_MMP_CAID_PU_DrugScreenTesting110119.PDFMMP Drug Screen Testing Update9/10/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_DrugScreenTesting110119.PDFDrug Screen Testing Update9/10/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_DrugScreenTesting110119.PDFDrug Screen Testing Update9/10/2019 12:00 AM2019WisconsinApproved
KYKY_CAID_PU_SBIRTFlier.pdfScreening Brief Intervention and Referral to Treatment (SBIRT) Flier9/18/2019 12:00 AM2019KentuckyApproved
WIWI_CAID_PU_AvailityMaternityModule.pdfNew pregnancy notification process using the Availity Portal Benefit Look-Up Tool9/18/2019 12:00 AM2019WisconsinApproved
ININ_CAID_PU_AvailityMaternityModule.pdfNew pregnancy notification process using the Availity Portal Benefit Look-Up Tool9/18/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_ClinicalCriteriaWebQ1.pdfClinical Criteria web posting Q1 20199/19/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_CustomizationforIPCancerTherapy.pdfMCG Care Guidelines update and customizations9/19/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_PArequpdateS2235Bulletin.pdfPrior Authorization requirement update for S2235 Bulletin9/20/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_CCRTConfigurationPAChnges.pdfPrior authorization requirements changes effective November 1, 2019 9/24/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_CCRTConfigurationPA Changes.pdfPrior authorization requirements changes effective November 1, 2019 9/24/2019 12:00 AM2019VirginiaApproved
ININ_CAID_PU_CCRTConfigurationPAChanges.pdfCCRT Configuration - PA Changes9/24/2019 12:00 AM2019IndianaApproved
WIWI_CAID_PU_CCRTConfigurationPAChanges.pdfCCRT Configuration - PA Changes9/24/2019 12:00 AM2019WisconsinApproved
NVNV_CAID_Jun2019CUMGupdates.pdfJune 2019 Medical Policies and CUMG Updates2019NevadaApproved
VAVA_CAID_PU_2Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective November 1, 20199/27/2019 12:00 AM2019VirginiaApproved
KYKY_CAID_PU_2Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective November 1, 20199/27/2019 12:00 AM2019KentuckyApproved
CACA_CAID_PU_2Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective November 1, 20199/27/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_InterQual2019Update.pdfInterQual 2019 update9/30/2019 12:00 AM2019NevadaApproved
CACA_CAID_PU_TerminationLocalCodeZ7610.pdfTermination of local code Z76109/30/2019 12:00 AM2019CaliforniaApproved
WIWI_CAID_PrenatalServiceThirdPartyLiabilityChange.pdfPrenatal service third-party liability change (Effective November 1st, 2019)2019WisconsinApproved
KYKY_CAID_PU_MPTACUpdateJun2019.pdfJune 2019 Medical Policies and Clinical Utilization Management Guidelines Update10/1/2019 12:00 AM2019KentuckyApproved
KYKY_CAID_PU_ClinicalCriteriaJuly2019.pdfClinical Criteria Web Posting July 201910/2/2019 12:00 AM2019KentuckyApproved
ININ_CAID_PU_MPTAC_Mar2019update.pdfMarch 2019 Medical Policies and Clinical Utilization Management Guidelines Update10/4/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_CertifiedRNAnesthetistAnesthesiaModifiers.pdfCertified registered nurse anesthetist — anesthesia modifiers10/4/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_MPTAC_Jun2019update.pdfJune 2019 Medical Policies and Clinical Utilization Management Guidelines Update10/4/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_CMSExpeditedRequest.pdfMMP CMS reminder: expedited/urgent requests10/7/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_CPAPSupplyLimitsPAUpdateBulletin.pdfCPAP supply limits and PA update10/8/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_BHFaxBackNotificationBulletin.pdfBehavioral health fax-back notification10/8/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_ClinicalCriteriaJuly2019.pdfClinical Criteria Web Posting July 201910/9/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_RemovalFormulaPABulletin.pdfEnteral formula PA requirement update10/9/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_340BBillingGuidanceUpdate.pdf340B Billing guidance update10/11/2019 12:00 AM2019KentuckyApproved
KYKY_CAID_PU_KentuckyPerinatalQualityCollaborationFlyer.pdfLaunch of the Kentucky Perinatal Quality Collaborative2019KentuckyApproved
KYKY_CAID_PU_MPTAC_Mar2019update.pdfMarch 2019 Medical Policies and Clinical Utilization Management Guidelines Update2019KentuckyApproved
CACA_CAID_PU_Global3M19MPTAC.pdfMMP-Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates10/18/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_ClinicalCriteriaAug2019.pdfClinical Criteria Web Posting August 201910/21/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_ClinicalCriteriaAugust2019.pdfClinical Criteria Web Posting August 201910/24/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_GlobalMedicareProvNotice.pdfMMP-Prior authorization requirements for E0784, K0553 and K055410/24/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_2Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective November 1, 201910/24/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_2Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective November 1, 201910/24/2019 12:00 AM2019NevadaApproved
KYKY_CAID_PU_RadiologyCardiologyBenefitsManagement.pdfRadiology and cardiology benefits management 2019KentuckyApproved
KYKY_CAID_PU_SemiAnnualCostofCareReview.pdfSemi Annual Cost of Care Review10/29/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_ClinicalCriteriaAug2019.pdfClinical Criteria Web Posting August 201910/30/2019 12:00 AM2019VirginiaApproved
KYKY_CAID_PU_AIMPrecertChanges.pdfChanges to precertification guidelines2019KentuckyApproved
CACA_CAID_PU_MedicaidGlobal3M19MPTACupdate.pdfMedicaid - Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/1/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_Global3M19MPTACupdate.pdfGlobal 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/4/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_Global3M19MPTAC.pdfGlobal 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/4/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_Global3M19MPTAC.pdfGlobal 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/4/2019 12:00 AM2019WisconsinApproved
KYKY_CAID_PU_Global3M19MPTAC.pdfGlobal 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/4/2019 12:00 AM2019KentuckyApproved
KYKY_CAID_PU_MedicallyDirectedAnesthesiaServices.pdfMedically directed anesthesia services11/5/2019 12:00 AM2019KentuckyApproved
CACA_CAID_PU_ReminderMedicareAdvantageProvidersReferInNetwork.pdfReminder to Medicare Advantage Providers- Refer In-Network11/5/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_CGPneumaticCompressionDevices.pdfNew clinical guideline: pneumatic compression devices, effective December 11, 201911/8/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_ClinicalCriteriaAug19.pdfClinical Criteria Web Posting August 201911/8/2019 12:00 AM2019NevadaApproved
WIWI_CAID_PU_ClinicalCriteriaAug19.pdfClinical Criteria Web Posting August 201911/8/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_ClinicalCriteriaAug19.pdfMMP - Clinical Criteria Web Posting August 201911/8/2019 12:00 AM2019CaliforniaApproved
ININ_CAID_PU_Global3M19MPTAC.pdfGlobal 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/8/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_FranciscanAllianceContractTermination.pdfFranciscan Alliance contract termination11/11/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_ClinicalCriteriaAugust2019.pdfClinical Criteria Web Posting August 20192019KentuckyApproved
NVNV_CAID_PU_BupNaloxoneClinicalCriteria.pdfBuprenorphine/Naloxone Clinical Criteria Update 2019NevadaApproved
CACA_CAID_PU_SpecialtyPharmacyPrecert.pdfSpecialty pharmacy precertification list11/14/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_Global3M19MPTAC.pdfGlobal 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates11/18/2019 12:00 AM2019NevadaApproved
CACA_CAID_PU_ProviderTermProcessPMGandIPA.pdfProvider termination process for primary medical groups and independent practice associations11/19/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_ProviderChangeNotification.pdfProvider notification process11/19/2019 12:00 AM2019CaliforniaApproved
CACA_MMP_2019AugustMPTACBulletin.pdfMMP - August 2019 Medical Policies and Clinical Utilization Management Guidelines Update11/21/2019 12:00 AM2019California, CAMMPApproved
KYKY_CAID_PU_PrecertChangesTargetedCaseManagement.pdfPrecertification requirement change2019KentuckyApproved
KYKY_CAID_PU_MPTAC_Aug2019update.pdfAugust 2019 Medical Policies and Clinical Utilization Management Guidelines Update11/21/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_MPTAC_Aug2019update.pdfAugust 2019 Medical Policies and Clinical Utilization Management Guidelines Update11/21/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_MPTAC_Aug2019update.pdfAugust 2019 Medical Policies and Clinical Utilization Management Guidelines Update11/21/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_ClinicalCriteriaSept2019.pdfClinical Criteria Web Posting September 201911/21/2019 12:00 AM2019CaliforniaApproved
NVNV_CAID_PU_ClinicalCriteriaSept2019.pdfClinical Criteria Web Posting September 201911/21/2019 12:00 AM2019NevadaApproved
WIWI_CAID_PU_ClinicalCriteriaSept2019.pdfClinical Criteria Web Posting September 201911/21/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_MPTAC_Nov2019.pdfAugust 2019 Medical Policies and Clinical Utilization Management Guidelines Update11/22/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_DxCodeListFINAL.pdf2020 Prenatal ultrasound diagnosis code update 11/14/2019 12:00 AM2019CaliforniaApproved
CACA_CAID_PU_CAHPSProviderTraining.pdfImproving the Patient Experience – CME11/25/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_CAHPSProviderTraining.pdfImproving the Patient Experience – CME11/25/2019 12:00 AM2019KentuckyApproved
VAVA_CAID_PU_CAHPSProviderTraining.pdfImproving the Patient Experience – CME11/25/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_CAHPSProviderTraining.pdfImproving the Patient Experience – CME11/25/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_EXPRESSPrenatalChanges.pdfPrenatal service third-party liability change11/26/2019 12:00 AM2019CaliforniaApproved
VAVA_CAID_PU_DiabetesMonthArticle.pdfNovember is Diabetes Awareness Month2019VirginiaApproved
NVNV_CAID_PU_Aug2019MedPoliciesCUMGUpdate.pdfAugust 2019 Medical Policies and Clinical Utilization Management Guidelines Update2019NevadaApproved
CACA_CAID_PU_RegulatoryUpdates_12_01_2019.pdfRegulatory Updates 12/1/201912/4/2019 12:00 AM2019CaliforniaApproved
WIWI_CAID_PU_WoundCareRequestUpdate.pdfWound care treatment request update2019WisconsinApproved
ININ_CAID_RemindertoFaxAllExpeditedAuthAppealReqs.pdfReminder to fax all expedited authorization appeal requests12/11/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_MPTAC_Aug2019update.pdfAugust 2019 Medical Policies and Clinical Utilization Management Guidelines Update12/13/2019 12:00 AM2019IndianaApproved
CACA_CAID_PU_MultipleBilateralSurgeryRP.pdfMultiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update 12/13/2019 12:00 AM2019CaliforniaApproved
CACA_MMP_CAID_PU_MultipleBilateralSurgeryRP.pdfMMP Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update 12/13/2019 12:00 AM2019California, CAMMPApproved
NVNV_CAID_PU_MultipleBilateralSurgeryRP.pdfMultiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update 12/13/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_MultipleBilateralSurgeryRP.pdfMultiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update 12/13/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_MultipleBilateralSurgeryRP.pdfMultiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update 12/13/2019 12:00 AM2019WisconsinApproved
CACA_CAID_PU_HospiceBillingInstructions.pdfHospice Billing Instructions12/20/2019 12:00 AM2019CaliforniaApproved
KYKY_CAID_PU_InterQualVersion20191Update.pdfInterQual 2019.1 update2019KentuckyApproved
VAVA_CAID_PU_QuarterlyPharmacyFormularyChangeNotice_Q32019.pdfQuarterly pharmacy formulary change notice effective January 1, 20202019VirginiaApproved
ININ_CAID_PU_PercentBilledChargeChange.pdfChange to percent billed charge12/19/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_ClinicalCriteriaSept2019.pdfClinical Criteria Web Posting September 201912/20/2019 12:00 AM2019IndianaApproved
ININ_CAID_PU_InterpreterServicesAvailable.pdfInterpreter services available12/20/2019 12:00 AM2019IndianaApproved
CACA_MMP_CAID_PU_Modifier62_CoSurgeons.pdfMMP Modifier 62: Co-Surgeons Reimbursement Policy Update12/23/2019 12:00 AM2019California, CAMMPApproved
ININ_CAID_PU_EPSDT_Article.pdfEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update12/23/2019 12:00 AM2019IndianaApproved
KYKY_CAID_PU_EPSDT_Article.pdfEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update12/23/2019 12:00 AM2019KentuckyApproved
NVNV_CAID_PU_EPSDT_Article.pdfEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update12/23/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_EPSDT_Article.pdfEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update12/23/2019 12:00 AM2019VirginiaApproved
WIWI_CAID_PU_EPSDT_Article.pdfEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update12/23/2019 12:00 AM2019WisconsinApproved
ININ_CAID_PU_NoncappedOxygenDMERequirementBulletin.pdfNoncapped oxygen DME PA requirement update12/26/2019 12:00 AM2019IndianaApproved
NVNV_CAID_PU_InterQual.pdfInterQual 2019.1 update12/27/2019 12:00 AM2019NevadaApproved
VAVA_CAID_PU_EXPRESSEVVclaimsdenial.pdfElectronic visit verification claims receiving denial code Z791/2/2020 12:00 AM2020VirginiaApproved
CACA_CAID_PU_3Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20201/2/2020 12:00 AM2020CaliforniaApproved
KYKY_CAID_PU_3Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20202020KentuckyApproved
VAVA_CAID_PU_EVV_DMAS_Update.pdfUpdate: electronic visit verification transition period extended2020VirginiaApproved
KYKY_CAID_PU_NewProviderManualAvailable.pdfNew! Provider manual now available2020KentuckyApproved
VAVA_CAID_PU_EMOverCodingRetraction.pdfRevision to evaluation and management services — over-coded services postponed1/10/2019 12:00 AM2020VirginiaApproved
NVNV_CAID_PU_3Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20202020NevadaApproved
ININ_CAID_PU_3Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20201/13/2020 12:00 AM2020IndianaApproved
ININ_CAID_PU_NewSpecPharmMedicalStepTherapy.pdfNew specialty pharmacy medical step therapy ESA/CSF requirements - Effective March 15, 20201/16/2020 12:00 AM2020IndianaApproved
NVNV_CAID_PU_NewSpecPharmMedicalStepTherapy.pdfNew Specialty Pharmacy Medical Step Therapy ESA/CSF Requirements - Effective March 1, 20201/16/2020 12:00 AM2020NevadaApproved
VAVA_CAID_PU_3Q19FormularyChangeNotice.pdfQuarterly pharmacy formulary change notice effective February 1, 20202020VirginiaApproved
WIWI_CAID_HealthyRewardsFlier.pdfHealthy Rewards Program2020WisconsinApproved
CACA_CAID_PU_WoundCareTreamentRequestUpdate.pdfWound care treatment request update1/23/2020 12:00 AM2020CaliforniaApproved
ININ_CAID_DenialforNoncoveredCodesAlert.pdfDenial of claims billed with noncovered codes1/23/2020 12:00 AM2020IndianaApproved
CACA_CAID_PU_RestorationofOptionalBenefits.pdfRestoration of optional benefits1/24/2020 12:00 AM2020CaliforniaApproved
CACA_CAID_PU_DevScrningSvcs.pdfGuidance for directed payments for developmental screening services1/24/2020 12:00 AM2020CaliforniaApproved
CACA_CAID_PU_ACEscreening.pdfGuidance for adverse childhood experiences screening service directed payments1/24/2020 12:00 AM2020CaliforniaApproved
ININ_CAID_PU_StepTherapyHereditaryAngioedemaInj.pdfNew specialty pharmacy medical step therapy HAE requirements1/27/2020 12:00 AM2020IndianaApproved
KYKY_CAID_PU_StepTherapyHereditaryAngioedemaInj.pdfNew specialty pharmacy medical step therapy HAE requirements1/27/2020 12:00 AM2020KentuckyApproved
CACA_CAID_PU_BrightHeartHealthMedAssistTreatProgram.pdfBright Heart Health medication-assisted treatment program1/28/2020 12:00 AM2020CaliforniaApproved
KYKY_CAID_PU_UrineDrugTestingPolicy.pdfUrine drug testing policy2020KentuckyApproved
KYKY_CAID_PU_IncorrectClaimsProcessingAlert.pdfIncorrect Claims Processing Alert2020KentuckyApproved
VAVA_CAID_PU_IncorrectClaimsPaymentsAlert.pdfIncorrect Claims Payments Alert2020VirginiaApproved
KYKY_CAID_PU_PsychTestingArticle.pdfCoding tip for psychological and neuropsychological testing2020KentuckyApproved
VAVA_CAID_PU_PsychTestingArticle.pdfCoding tip for psychological and neuropsychological testing2020VirginiaApproved
WIWI_CAID_PU_PsychTestingArticle.pdfCoding tip for psychological and neuropsychological testing2020WisconsinApproved
ININ_CAID_PU_IncorrectClaimsPaymentAlertTemplate.pdfIncorrect Claims Payment Alert2/6/2020 12:00 AM2020IndianaApproved
CACA_CAID_PU_ClinicalCriteriaNov2019.pdfClinical Criteria Web Posting November 20192/7/2020 12:00 AM2020CaliforniaApproved
NVNV_CAID_PU_ClinicalCriteriaNov2019.pdfClinical Criteria Web Posting November 20192/7/2020 12:00 AM2020NevadaApproved
VAVA_CAID_PU_ClinicalCriteriaNov2019.pdfClinical Criteria Web Posting November 20192/7/2020 12:00 AM2020VirginiaApproved
WIWI_CAID_PU_ClinicalCriteriaNov2019.pdfClinical Criteria Web Posting November 20192/7/2020 12:00 AM2020WisconsinApproved
WIWI_CAID_PU_PersonalCareAgencyUpdate.pdfPersonal care prior authorization2020WisconsinApproved
WIWI_CAID_PU_PriorAuthA6550-A9278.pdfPrior authorization requirements for A6550 and A92782020WisconsinApproved
CACA_CARE_PU_PsychNeuroPsychTestingCodingTip.pdfCoding tip for psychological and neuropsychological testing2/12/2020 12:00 AM2020CaliforniaApproved
CACA_MMP_MedicalPoliciesClinicalUMGuidelinesNov2019.pdfMMP - November 2019 Medical Policies and Clinical Utilization Management Guidelines update2/13/2020 12:00 AM2020California, CAMMPApproved
KYKY_CAID_PU_HospitalAssignmentList.pdfProvider Solutions Hospital Assignments2/13/2020 12:00 AM2020KentuckyApproved
KYKY_CAID_PU_ProviderSolutionsRealignment.pdfProvider Solutions territory realignment2/13/2020 12:00 AM2020KentuckyApproved
KYKY_CAID_PU_ProviderSolutionsTerritoryMap.pdfProvider Solutions Regions2/13/2020 12:00 AM2020KentuckyApproved
CACA_MMP_CAID_PU_ClincalCriteriaNov2019.pdfMMP Clinical Criteria Web Posting November 20192/13/2019 12:00 AM2020CaliforniaApproved
VAVA_CAID_PU_ValueAddedVisionBenefitHealthKeepersPlus.pdfNew value-added benefit for Anthem HealthKeepers Plus members3/19/2020 12:00 AM2020VirginiaApproved
ININ_CAID_PU_FalseClaimsActAwareness.pdfFalse Claims Act awareness2/18/2020 12:00 AM2020IndianaApproved
CACA_CAID_PU_NewSpecRxMedicalInjectableStepTherapyReqs.pdfNew Specialty Pharmacy Medical Injectable Step Therapy Requirements2/19/2020 12:00 AM2020CaliforniaApproved
CACA_CAID_PU_NewSpecRxMedicalStepTherapyReqs.pdfNew Specialty Pharmacy Medical Step Therapy Requirements2/19/2020 12:00 AM2020CaliforniaApproved
KYKY_CAID_PU_ClinicalCriteriaSept2019.pdfClinical Criteria Web Posting September 20192/20/2020 12:00 AM2020KentuckyApproved
ININ_CAID_PU_PsychTestingArticle.pdfCoding tip for psychological and neuropsychological testing2/20/2020 12:00 AM2020IndianaApproved
NVNV_CAID_PU_CodingTipPsychNeuropsychTesting.pdfCoding tip for psychological and neuropsychological testing2/20/2020 12:00 AM2020NevadaApproved
CACA_CAID_PU_ClinicalCriteriaDec2019.pdfClinical Criteria Web Posting December 20192/20/2020 12:00 AM2020CaliforniaApproved
NVNV_CAID_PU_ClinicalCriteriaDec2019.pdfClinical Criteria Web Posting December 20192/20/2020 12:00 AM2020NevadaApproved
VAVA_CAID_PU_ClinicalCriteriaDec2019.pdfClinical Criteria Web Posting December 20192/20/2020 12:00 AM2020VirginiaApproved
WIWI_CAID_PU_ClinicalCriteriaDec2019.pdfClinical Criteria Web Posting December 20192/20/2020 12:00 AM2020WisconsinApproved
CACA_MMP_PU_ClinicalCriteriaDec2019.pdfMMP Clinical Criteria Web Posting December 20192/20/2020 12:00 AM2020California, CAMMPApproved
CACA_MMP_PU_PriorAuthNewCodesCovPrecert.pdfMMP - Prior authorization requirements: new 2020 codes for coverage and precertification2/24/2020 12:00 AM2020California, CAMMPApproved
VAVA_CAID_PU_MPTACBulletinNov2019.pdfNovember 2019 Medical Policies and Clinical Utilization Management Guidelines update2/27/2020 12:00 AM2019VirginiaApproved
CACA_CAID_PU_MPTAC_Nov2019update.pdfNovember 2019 Medical Policies and Clinical Utilization Management Guidelines update2/28/2020 12:00 AM2020CaliforniaApproved
WIWI_CAID_PU_MPTAC_Nov2019update.pdfNovember 2019 Medical Policies and Clinical Utilization Management Guidelines update2/28/2020 12:00 AM2020WisconsinApproved
CACA_CAID_PU_AccesstoCareStandards.pdfAccess to care standards3/2/2020 12:00 AM2020CaliforniaApproved
CACA_CAID_PU_CLIAImplementationProviderNotification.pdfCLIA Implementation Provider Notification3/4/2020 12:00 AM2020CaliforniaApproved
ININ_CAID_PU_ClinicalCriteriaWebPostNov2019.pdfClinical Criteria Web Posting November 20193/6/2020 12:00 AM2020IndianaApproved
CACA_CAID_PU_Q1NewCodesCovPrecert.pdfPrior authorization requirements: new 2020 codes for coverage and precertification3/6/2020 12:00 AM2020CaliforniaApproved
VAVA_CAID_PU_Q1NewCodesCovPrecert.pdfPrior authorization requirements: new 2020 codes for coverage and precertification3/6/2020 12:00 AM2020VirginiaApproved
WIWI_CAID_PU_Q1NewCodesCovPrecer.pdfPrior authorization requirements: new 2020 codes for coverage and precertification3/6/2020 12:00 AM2020WisconsinApproved
CACA_CAID_PU_ABAFeeScheduleUpdate.pdfApplied behavior analysis fee schedule update3/9/2020 12:00 AM2020CaliforniaApproved
KYKY_CAID_PU_NewCodesCovPrecert.pdfPrior authorization requirements: new 2020 codes for coverage and precertification2020KentuckyApproved
KYKY_CAID_PU_Providerdatavalidation.pdfProvider data validation survey3/11/2020 12:00 AM2020KentuckyApproved
ININ_CAID_PU_ClinicalCriteriaWebPostDec2019.pdfClinical Criteria Web Posting December 20193/12/2020 12:00 AM2020IndianaApproved
ININ_CAID_PU_PriorityFUAQualityDocumentationTool.pdfQuality Documentation Tool3/13/2020 12:00 AM2020IndianaApproved
ININ_CAID_PU_RightChoicesProgramUpdate.pdfRight Choices Program update3/13/2020 12:00 AM2020IndianaApproved
ININ_CAID_PU_CPTCategoryIICodeReimbursement.pdfCPT Category II code reimbursement3/13/2020 12:00 AM2020IndianaApproved
KYKY_CAID_PU_TalkingPointsCOVID19.pdfCOVID-19 information from Anthem Blue Cross and Blue Shield Medicaid (3/26/2020)3/26/2020 12:00 AM2020KentuckyApproved
NVNV_CAID_PU_TalkingPointsCOVID19.pdfCOVID-19 information from Anthem Blue Cross and Blue Shield Healthcare Solutions (3/26/2020)3/26/2020 12:00 AM2020NevadaApproved
WIWI_CAID_PU_TalkingPointsCOVID19.pdfCOVID-19 information from Anthem Blue Cross and Blue Shield (3/26/2020)3/26/2020 12:00 AM2020WisconsinApproved
CACA_CAID_PU_COVID19VirusTalkingPoints.pdfCOVID-19 information from Anthem Blue Cross3/13/2020 12:00 AM2020CaliforniaApproved
ININ_CAID_PU_TalkingPointsCOVID19.pdfCOVID-19 information from Anthem Blue Cross and Blue Shield (3/18/2020)3/18/2020 12:00 AM2020IndianaApproved
VAVA_CAID_PU_LTSSAuthExtensionNotice.pdfAuthorizations extended for LTSS services due to COVID-192020VirginiaApproved
VAVA_CAID_PU_TalkingPointsCOVID19.pdfCOVID-19 information from HealthKeepers, Inc. (March 26, 2020)3/26/2020 12:00 AM2020VirginiaApproved
KYKY_CAID_PU_ClinicalCriteriaDec2019.pdfClinical Criteria Web Posting December 20193/20/2020 12:00 AM2020KentuckyApproved
VAVA_CAID_PU_ProviderFlexibilitiesRelatedToCOVID19.pdfProvider Flexibilities Related to COVID-19 (March 19, 2020)3/23/2020 12:00 AM2020VirginiaApproved
NVNV_CAID_PU_COVID19PharmDiagCode.pdfHydroxychloroquine and Chloroquine Diagnosis Requirements on Prescriptions (March 20, 2020)2020NevadaApproved
VAVA_CAID_PU_EXPRESSDMASLtrCOVID-19Notice.pdfChanges related to COVID-19 (March 25, 2020)3/25/2020 12:00 AM2020VirginiaApproved
VAVA_CAID_PU_COVID19DMASFAQs.pdfDMAS COVID-19 Frequently Asked Questions (March 26, 2020)3/26/2020 12:00 AM2020VirginiaApproved
CACA_CAID_PU_COVID19CommunicationTelehealthQandA.pdfCOVID-19 Communication Telehealth Q&A3/26/2020 12:00 AM2020CaliforniaApproved
ININ_CAID_PU_MedicaidSiteofCareExpansion.pdfIndiana Medicaid Site of Care Expansion3/26/2020 12:00 AM2020IndianaApproved
CACA_CAID_PU_COVID19VirusTalkingPointsUpdate032520.pdfCOVID-19 information from Anthem Blue Cross (March 25 update)3/27/2020 12:00 AM2020CaliforniaApproved
TitleHTMLMenuApproval StatusMarket
The Anthem Network
  • Join Our Network
1.1ApprovedCalifornia
Prior Authorization & Claims
  • Request Prior Authorization
  • Prior Authorization Lookup Tool
  • Submit Claims & Appeals
  • Electronic Data
    Interchange (EDI)
  • Medicaid Reimbursement Policies
  • MMP Reimbursement Policies
2.1ApprovedCalifornia
Member Eligibility & Benefits
  • Eligibility Roster & Capitation Reports
  • Plan Information
  • Pharmacy Benefits
3.1ApprovedCalifornia
Provider Support
  • Helping Members
    • Disease Management
      Useful Health Information
    • TeleHealth
      Live Patient Consultations
    • Health Education Programs
    • Staying Healthy Assessment
    • Prenatal Resources
    • Language Assistance Program
    • Free Interpreting Services
    • EPSDT
    • Tobacco Cessation
    • Health Home
    • Safe Choice Program
  • Education & Resources
    • Continuing Medical Education
    • Communications & Updates
    • Manuals, Training & more
  • Forms
  • Quality Assurance
    • Quality Improvement Program
    • Behavioral Health Clinical
      Practice Guidelines
    • Preventive Healthcare Guidelines
  • Find a Doctor
4.1ApprovedCalifornia
The Anthem Network
  • Join Our Network
1.1ApprovedIndiana
Prior Authorization & Claims
  • Prior Authorization
  • Prior Authorization Lookup Tool
  • Submit Claims & Appeals
  • ICD-10
  • Electronic Data Interchange (EDI)
  • Reimbursement Policies
2.1ApprovedIndiana
Member Eligibility & Benefits
  • Member Eligibility
  • Program Information
  • Pharmacy Benefits
3.1ApprovedIndiana
Provider Support
  • Education & Resources
    • Communications & Updates
    • Manuals, Training & more
    • Improving the Patient
      Experience CME
    • Anthem Indiana Medicaid Academy
  • Quality Assurance
    • Quality Improvement Program
    • Preventive Healthcare Guidelines
    • Behavioral Health CPG
  • Helping Members
    • Disease Management
      Useful Health Information
    • Member & Health Education
    • EPSDT
    • Cultural & Linguistic Resources
    • Maternal Services
  • Forms
  • Find a Doctor
4.1ApprovedIndiana