Provider responsibilities & standards news
- 06/30/2020: Change to behavioral health immediate reconsideration reviews
- 06/08/2020 Talking to your patients about pharyngitis testing
- 05/14/2020: May medical policy updates
- 05/01/2020: Updated process for peer-to-peer reviews starts July 1
- 04/28/2020 Change Healthcare to begin Medicare chart reviews
- 04/08/2020: COVID-19 update: Moving providers to different locations and credentialing new providers to support COVID-19 volumes
- 03/13/2020: Hospitals: New Medicare Outpatient Observation Notice
- 02/26/2020: Feb. 2020 medical policy updates
- 01/02/2020 provider news: 2020 PriorityMedicare D-SNP MOC training now available
- 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
- 09/28/2018: 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