Provider responsibilities & standards news
- 07/16/2019: Medicaid CHAMPS prescriber enrollment requirement effective Oct. 1, 2019
- 06/25/2019: Refer members to in-network providers
- 06/11/2019: Change Healthcare to begin chart reviews
- 06/06/2019: New Medicare Quality Improvement Organization for MI
- 04/15/2019: InterQual will replace observation local rules
- 01/16/2019: Updated discharge policy and new online discharge process
- 01/07/2019: Vendor pre-scheduling HEDIS chart retrievals now
- 12/11/2018: Chart reviews starting soon by Altegra/Change Healthcare
- 11/02/2018: Medicaid behavioral health outpatient therapy clinical review process
- 11/02/2018: Medicare step therapy proposed Jan. 1, 2019
- 11/01/2018: Update to member discharges in 2019
- 10/30/2018: Reminder: Appropriate testing for children with Pharyngitis
- 10/25/2018: Appropriate treatment for children with upper respiratory infections
- 09/28/2019: Starting Dec. 3, 2018, inpatient urgent/emergent admissions review process change
- 09/27/2018: Medicaid CHAMPS enrollment requirement effective Jan. 1, 2019
- 08/08/2018: Reminder: Provider directory update requirements
- 06/06/2018: Chart reviews starting soon
- 06/05/2018: Risk adjustment validation through Cognisight
- 01/01/2018: CHAMPS enrollment required for Medicaid providers by Jan. 1
- 02/08/2018: HEDIS medical record collection has started
- 12/22/2017: MyPriority chart review through Altegra Health
- 11/28/2017: Required screenings/notification for fraud, waste & abuse
- 07/20/2017: Altegra risk adjustment Medicare chart reviews
- 02/08/2017: Modifiers 59, XE, XS, XP and XU medical record requirement changes