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Providers
Updates and Notices
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Providers
Updates and Notices
Updates and Notices
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MDM Expansion: Prior Authorization Required Effective July 15, 2022
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EVV Provider Survey
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Recall: New Credentialing Requirements for Organizational Providers
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Updated Claims and Billing Guidelines for FQHC (Effective Mar. 4, 2022)
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Methadone Reimbursement to Increase Effective March 1, 2022
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MDM Expansion: Prior Authorization Required Effective March 15, 2022
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Mandatory Provider Enrollment for All HHO Providers Servicing Delaware Medicaid
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LTSS Service Authorizations Extension
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Billing Change for DME NOC and Miscellaneous Codes
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Shared Health Migrated to Highmark Health Options Support Center
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Pharmacy and Durable Medical Equipment (DME) Guidelines (Updated Nov. 10, 2021)
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MDM Expansion: Prior Authorization Required Effective January 1, 2022
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New Provider Portal and Temporary Manual Process for Authorization Submissions
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MSK Provider Orientation Session Invite
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Prior Authorization Required from eviCore Healthcare for Musculoskeletal Services Only Starting Nov. 1, 2021
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July Provider Forum Invitation
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MDM Expansion: Prior Authorization Required Effective September 1
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MDM Expansion: Prior Authorization Required for Myobloc and Xeomin
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May 2021 Provider Forum
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Reminder: LabCorp is the Preferred Provider for Outpatient Laboratory Testing
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Billing Change for Durable Medical Equipment Not Otherwise Classified (DME NOC) and Miscellaneous Codes
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Risk Adjustment Provider Education and Demonstration Invitation
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Professionals-Submitting a Corrected Claim Fax
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Facility-Submitting a Corrected Claim Fax
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MDM Expansion Notification
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Medical Coverage of COVID-19 Vaccine Administration | Info & FAQs
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Claims Disputes
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New EVV Go-Live Date is July 1, 2021
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Provider Orientation Sessions for Radiology and Cardiology Prior Authorizations
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Biosimilar Step Requirement
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October 2020: Reminder Specific Medications Require Prior Authorization
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October 2020 DMMA Electronic Visit Verification Survey for Community Based Services, Home Health and Personal Care Service Providers
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HHO Outpatient Claims EOB Submission
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Sept 2014 MEDICAID PROGRAM UPDATE
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Oct 2014 FEE SCHEDULE UPDATE
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Oct 2014 MEDICAID PROGRAM UPDATE
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Nov 2014 HEALTH OPTIONS WORKSHOP
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Nov 2014 CORRECTIONS TO THE HEALTH OPTIONS WORKSHOP
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Dec 2014 PROVIDER MANUAL NOW ONLINE
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Dec 2014 PROVIDER MANUAL UPDATED
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Dec 2014 FREQUENTLY ASKED QUESTIONS
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Dec 2014 CONTINUITY OF CARE AND AUTHORIZATION REQUESTS
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Dec 2014 RADIOLOGY MANAGEMENT PROGRAM BEGINS FEB. 1, 2015
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Jan 2015 FREQUENTLY ASKED QUESTIONS
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Jan 2015 SUBMITTING AUTHORIZATION REQUESTS
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Jan 2015 PHYSICAL & OCCUPATIONAL THERAPY DAILY MAXIMUM INCREASED
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Jan 2015 PCP ASSIGNMENTS AND OUTPATIENT LAB SERVICES
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Jan 2015 MEMBER ID CARDS AND PCP ASSIGNMENTS
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Jan 2015 FORMULARY AND PHARMACY UPDATE
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Feb 2015 BEHAVIORAL HEALTH SERVICES
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Feb 2015 CLAIM SUBMISSION REMINDERS
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Feb 2015 AUTHORIZATION REQUIREMENTS FOR HEALTH OPTIONS MEMBERS ARE IN PLACE
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Feb 2015 NIA PROGRAMS
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Feb 2015 VACCINE REIMBURSEMENTS
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Feb 2015 PROVIDER FORUMS
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Mar 2015 EFT AND ERA
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Mar 2015 LONG-TERM SUPPORT SERVICES (LTSS) AUTHORIZATION UPDATE
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April 2015 UPDATE ON NAVINET ACCESS
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May 2015 PROVIDER RELATIONS REPRESENTATIVE TERRITORY CHANGES
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June 2015 LONG TERM SERVICES AND SUPPORTS TO REQUIRE AUTHORIZATION, EFFECTIVE JUNE 15, 2015
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June 2015 VACCINE BILLING PROCEDURE DIFFERS FOR CHILDREN AND ADULTS (CLARIFICATION)
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July 2015 AUTHORIZATION UPDATE - FOR LTSS PROVIDERS
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July 2015 EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) PROGRAM
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July 2015 ICD-10 COMPLIANCE DATE QUICKLY APPROACHING
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July 2015 ICD-10 REMINDER AND NEW APPEALS AND GRIEVANCE ADDRESS
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Oct 2015 ENHANCED CLINICAL EDITING PROCESSES
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Jan 2016 ADJUSTMENTS TO REIMBURSEMENT RATES
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Jan 2016 ENHANCED CLINICAL EDITING PROCESSES
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Jan 2016 ORAL CARE
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Feb 2016 FLUORIDE VARNISH — THE PHYSICIAN'S ROLE IN CHILDREN’S ORAL HEALTH
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Feb 2016 PROVIDER FORUMS – LTSS FOCUS
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Apr 2016 ADJUSTMENTS TO REIMBURSEMENT RATES
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May 2016 NEW FAX NUMBERS AVAILABLE FOR SUBMITTING AUTHS (MEDICAID)
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May 2016 MY DIABETES REPORT CARD MAILING
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June 2016 READMISSIONS AND RETROSPECTIVE AUTHORIZATIONS
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June 2016 ADJUSTMENTS TO REIMBURSEMENT RATES/BILLING CODES FOR INSTITUTIONS FOR MENTAL DISEASE (IMDs)
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June 2016 STATE REVISIONS AND UPDATES TO THE COMPREHENSIVE MEDICAL REPORT B (MAP B) FORM
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June 2016 ADJUSTMENTS TO IUD REIMBURSEMENT RATES
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June 2016 READMISSIONS AND RETROSPECTIVE AUTHORIZATIONS
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June 2016 ENHANCED CLINICAL EDITING PROCESSES
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July 2016 New Fax Number for Claim Appeals and Correction From Previous Bulletin
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Aug 2016 PLEASE COMPLETE & RETURN IMPORTANT RISK-GAP CLOSURE FORMS
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Aug 2016 REMINDER TO TRACK MISSED HOME CARE VISITS
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Sept 2016 NEW PHONE NUMBER FOR PROVIDERS
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Sept 2016 NEW REIMBURSEMENT RATES FOR LUCENTIS AND EYLEA, EFFECTIVE SEPT. 1
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Sept 2016 HIGHMARK HEALTH OPTIONS PROVIDER FORUMS
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Sept 2016 ENHANCED CLINICAL EDITING PROCESS — EIGHT NEW DRUG POLICIES AIM TO PROMOTE CORRECT CODING
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Sept 2016 REPORT CRITICAL INCIDENTS WITHIN TWO BUSINESS DAYS
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Sept 2016 REMINDER: ATTEND A HIGHMARK HEALTH OPTIONS PROVIDER FORUM
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Jan 2017 PCPS: WATCH YOUR MAIL FOR NEW PHYSICIAN PORTFOLIO
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Jan 2017 HIGHMARK HEALTH OPTIONS LAUNCHES COMMUNITY REPOSITORY
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Feb 2017 PROVIDER PLAN OF CARE PROCESS ENHANCED
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June 2017 YOU’RE INVITED TO OUR PROVIDER FORUMS
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July 2017 INTRODUCTION LETTER TO THE OPERATIONAL CHANGES EFFECTIVE SEPT 2017
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Aug 2017 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE SEPT. 1
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Aug 2017 YOU’RE INVITED TO OUR PROVIDER FORUMS (8/14, 8/15 and 8/16)
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Aug 2017 EPSDT REPORTS ARE NOW AVAILABLE ON NAVINET
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Oct 2017 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE NOV 1
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Oct 2017 MY DIABETES REPORT CARD
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Nov 2017 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JANUARY 8TH, 2018
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Dec 2017 LTSS PROVIDER AUTHORIZATION UPDATE
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Dec 2017 NEW OPERATING PLATFORM (EHS) TO GO LIVE JAN 1
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Dec 2017 IMPORTANT CHANGES RELATED TO NEW OPERATING PLATFORM TRANSITION
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Jan 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE FEB 15
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Jan 2018 PROVIDER EDUCATION WEBINARS: NEW EHS OPERATING SYSTEM
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Jan 2018 NOTICE OF PRIOR AUTHORIZATION CODES REMOVAL EFFECTIVE FEB. 15
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Jan 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE MARCH 5TH, 2018 (REVISED)
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Jan 2018 SUBSTANCE ABUSE TREATMENT PRIOR AUTHORIZATION PROCEDURE CHANGE
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Feb 2018 PROVIDER FORUM INVITATION
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Feb 2018 2017 Provider Survey Results
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Mar 2018 Recognizing and Reporting Quality of Care and Quality of Service Concerns
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Apr 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE MAY 15
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May 2018 SELF AUDITS/OVERPAYMENTS
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June 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE SEPT 3, 2018
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June 2018 LabCorp is Preferred Provider for Outpatient Laboratory Testing
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July 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE AUG 15
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Aug 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE OCT 1, 2018
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Sept 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE DEC 3, 2018
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Sept 2018 PROVIDER FORUM INVITATION
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Oct 2018 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE Nov 15
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Jan 2019 NEW PERMANENT PROCEDURE CODE ASSIGNED, EFFECTIVE JAN 1, 2019
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Jan 2019 DE MEDICAID RETROSPECTIVE RISK GAP CLOSURE CAMPAIGN WILL LAUNCH JAN. 2, 2019
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Jan 2019 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE FEB 15
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Jan 2019 BILATERAL PROCEDURES
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Jan 2019 Change in Authorization Process for Home and Community Based (HCBS) Providers
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Mar 2019 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JUNE 3, 2019
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Apr 2019 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE May 6, 2019
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May 2019 MEDICAL POLICIES EFFECTIVE JUNE 3, 2019
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June 2019 NEW REMITTANCE ADVICES ADDRESS OFFSETS
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Jun 2019 ATLAS QUARTERLY OUTREACH
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Jul 2019 TAXONOMY REQUIRED ON CLAIMS SUBMISSIONS
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Jul 2019 RETRO REVIEW PROCESS CHANGE
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Jul 2019 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE November 4, 2019
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Aug 2019 MEDICAL POLICIES EFFECTIVE SEPT 16, 2019
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Sept 2019 2019 PROVIDER SATISFACTION SURVEY BEGINS IN SEPTEMBER
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Sept 2019 YOU’RE INVITED TO OUR PROVIDER FORUMS
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Oct 2019 MEDICAL POLICIES EFFECTIVE NOV 4, 2019
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Oct 2019 JOIN US TO DISCUSS EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) 10/23 OR 10/24
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Nov 2019 CARE COORDINATORS AND LTSS CASE MANAGERS – TEMPORARILY NOT ACCEPTING DIRECT FAXES
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June 2020 June Virtual Provider Forum Invitation
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June 2020 Resubmitting a Claim with a New EOB
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June 2020 Appeals and Grievances Department – July 5 Contact Changes
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June 2020 Submitting Correct Indicator When Medicare Advantage Plan is the Primary Payer
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May 2020 Commercial Insurance Disallowance Process
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May 2020 Billing for Home Delivered Meals
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Apr 2020 ICD-10-CM Official Guidelines for Coding and Reporting: Excludes Notes
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Mar 2020 COVID-19 Telehealth Policy Update
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Mar 2020 COVID-19 Updates and Information
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Feb 2020 Billing for Home Delivered Meals
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Feb 2020 DPH Information on Monitoring Returning Travelers for Coronavirus
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Jan 2020 2020 CPT Codes and Updates