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Special Bulletins/Mailings

2014 Mailings

MA Medical Policies to Provide Clinical Criteria for Select Outpatient Facility Services

Facilty: MA Outpatient Behavioral Health Fee Schedule Changes Effective December 1, 2014

Facilities: MA 29 Medical Policies Apply to Outpatient Facility Services

Change in Freedom Blue PPO Structure, New NAIC Number Beginning January 1, 2015

Skilled Nursing Facilities: Change in Assessment Reporting Process for Medicare Advantage Members

Skilled Nursing Facilities: Reporting Assessment Indicators for Medicare Advantage Members

Prior Authorization Required for Aloxi, Neulasta, Tysabri and 7 Additional Chemotherapy Drugs, Effective 11/3/14

Prior Authorization Requirement for Aloxi & Neulasta Delayed Until 11/3/2014

Facilities: MA 16 Medical Policies Apply to Outpatient Facility Services on 10/27/14

Facilities: Prior Authorization Required for Aloxi, Camptosar, Gemzar & Neulasta Starting 9/1/14

Facilities: Register now for a Webinar or Educational Session with NaviHealth

Facilities: Register Now for Educational Session with NAVIHEALTH

Clarification Regarding Non-Coverage Determinations for Medicare Advantage Members

Avastin, Eloxatin, Herceptin & Rituxan Require Prior Authorization Beginning 7/1/2014

MA Outpatient Behavioral Health Fee Schedules EFF 5/1/2014

8 Drugs Added for Self-Administered Injectable or Oral Biotechnology Drugs, Eff 4/7/14

Changes to Highmark Medical Injectable Drug Program

Revised HIPPS Codes on Medicare Advantage Claims for HH and SNF Providers

Authorization Required for ESRD Related Prescription Drugs for Medicare Advantage

Highmark to Change Source for Clinical Laboratory Fees, Eff. March 3, 2014

Requirements for Non-Emergency Transportation for Medicare Advantage Members