2023
- Medicare Step Therapy Part B Drug List - Effective January 1, 2024
- 2024 Formulary Change Notification
- National Epic Payer Platform Announcement
- Prior Authorization Codes for Leg Stents and Related Services
- Find-a-Provider Directory Communications: Phase 1
- Important Pharmacy Claims Processing Change, Effective January 1, 2024
- Review Criteria Change: 72 Hour Rule Enhancement
- EDI-275: Additional Provider Portal Functionality
- Medicare Prior Authorization Changes Effective October 1, 2023
- Annual Special Needs Plan Model of Care (MOC) Training
- Reminder: Home Health Notice of Admission (NOA) Change
- Termination of Somatus Care Management Program for Patients with CKD/ESRD
- COVID-19 Public Health Emergency (PHE) Expiration - Effective May 11, 2023
- Medicare Prior Authorization Change Summary - Effective July 1, 2023
- Appendix A - Medicare Part B Drug List - Effective July 1, 2023
- D-SNP Patients Must Verify Medicaid Eligibility Annually
- ICD 10 Correct Coding Edits
- Reminder of CMS Lab Ordering Guidelines
- Medicare Synergy Edits
- Guidance on Effective Date for Legacy Wellcare Medicare ID Cards
- Wellcare 2023 $0 Immunizations Part D Vaccines - (PDF)
2022
- Special Needs Plan Model of Care Self-Study Program
- Medicare Part B Drugs List: Effective January 1, 2023 (Appendix A)
- Medicare Prior Authorization Change Summary: Effective January 1, 2023
- CMS Lab Ordering Guidelines Reminder
- Update: Treatment Room Payment Policy
- Peer-to-Peer Review Request Requirement Changes Effective September 1, 2022
- InterQual Criteria Rollout: Effective August 1, 2022
- Prior Authorization Change Summary: Effective July 1, 2022
- Retraction of Medicare Advantage Termination Notice
- Wellcare Expands Footprint into NC Health Insurance Marketplace
- Medicare PPO Provider Billing Awareness
- Prior Authorization Requirement Updates: Effective March 1, 2022
- Temporary COVID-19 Provisions: Post-Acute Care & Hospital at Home
- 275 Claim Attachment Transactions via EDI
2021
- National Imaging Associates (NIA) Implementation Announcement
- CPP 161: Polymerase Chain Reaction Respiratory Viral Panel Testing
2020
- Claims and Payment Policy: Review of NOS, NEC and Unlisted Codes
- New Prepay Edits: Institutional Ambulance Claims
- Prepayment Clinical Validations Edit Policy
- Comprehensive Eye Exam Claim and Payment Policy
- $0 Member Liability extended for select services until end of 2020
- CPP 145: Incorrect Billing for Severe Malnutrition Policy
- Prior Authorization Updates: Wound Care & Skin Substitutes
- Revised ED Outpatient Facility E/M Coding Policies
- Opioid Program MAT Certification
