medical

Home

Administrative

Billing & Reimbursement

Medical

The Medical section is designated for information pertaining to services covered under the medical benefit, including new and updated medical and claim payment policies, precertification changes, and utilization management programs.

Communications

2023 Updates

Medi
2022 Updates
- •
  2023 Medicare Part D insulin and vaccine coverage updates Posted: 12/23/2022
- •
  Changes to medical policy on insertion of implantable infusion pumps Posted: 12/22/2022
- •
  November policy updates include automatic external cardioverter defibrillators Posted: 12/19/2022
- •
  Changes to the Most Cost-Effective Setting Program Posted: 12/14/2022
- •
  Medicare Advantage telehealth reimbursement rate update Posted: 12/1/2022
- •
  Changes to medical policy on percutaneous coronary intervention, coronary angiography, and arterial ultrasound Posted: 11/23/2022
- •
  Changes to medical policy on high-technology radiology services Posted: 11/23/2022
- •
  Changes to medical policy on musculoskeletal services Posted: 11/23/2022
- •
  Important alert about Labcorp in-home screenings Posted: 11/22/2022
- •
  Temporary suspension of precertification for nutritional formulas and enteral nutrition Posted: 11/17/2022
- •
  October policy updates Posted: 11/10/2022
- •
  Upcoming: Updates to the medical benefit specialty drug cost-share list Posted: 11/7/2022
- •
  Changes to medical policy on ostomy supplies Posted: 11/4/2022
- •
  Update to medical policy on maintenance treatment of opioid or alcohol use disorder Posted: 11/1/2022
- •
  Notification of policies going into effect January 1, 2023 Posted: 11/1/2022
- •
  Ordering Synagis^® (palivizumab) for the 2022-2023 RSV season Posted: 10/20/2022
- •
  Upcoming: Updates to the list of specialty drugs that will require precertification Posted: 10/18/2022
- •
  Changes to medical policy on radiation therapy services Posted: 10/17/2022
- •
  Expanded coverage of pneumococcal 15-valent conjugate vaccine for Commercial members Posted: 10/12/2022
- •
  September policy updates Posted: 10/10/2022
- •
  Musculo pilot program now available Posted: 10/10/2022
- •
  Changes to medical policy on Pemetrexed (Alimta^®), Pemetrexed (Pemfexy™) Posted: 10/7/2022
- •
  Changes to medical policy on pneumatic compression therapy devices Posted: 9/23/2022
- •
  Changes to medical policy on Eculizumab (Soliris^®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris^®) Posted: 9/19/2022
- •
  Monkeypox: Member coverage for laboratory testing, vaccination, and treatment Posted: 9/13/2022
- •
  Changes to policy on musculoskeletal services Posted: 9/12/2022
- •
  Changes to policy on sleep disorder testing and positive airway pressure therapy services and supplies Posted: 9/12/2022
- •
  Update to policy on high-technology radiology services Posted: 9/12/2022
- •
  August policy updates Posted: 9/6/2022
- •
  Change to medical policy on Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend^®), Granisetron (Sustol^®), and Rolapitant (Varubi^®) Posted: 8/30/2022
- •
  Changes to medical policy on outpatient physical medicine, rehabilitation, and habilitation services Posted: 8/29/2022
- •
  Change to medical policy on home health care services Posted: 8/29/2022
- •
  Reminder: CRNP and PA credentialing and reimbursement Posted: 8/16/2022
- •
  Changes to medical policy on wheelchair cushions and seating Posted: 8/16/2022
- •
  Changes to medical policy on home prothrombin time monitoring Posted: 8/16/2022
- •
  Changes to medical policy on hospital beds and accessories Posted: 8/12/2022
- •
  July policy updates Posted: 8/5/2022
- •
  Updated InterQual^® Criteria for 2022 Posted: 7/28/2022
- •
  New policy on Aducanumab (Aduhelm^TM) for Alzheimer disease Posted: 7/26/2022
- •
  New collaboration with Cayaba Care aims to reduce maternal morbidity Posted: 7/20/2022
- •
  Updates to medical policy on obstructive sleep apnea and primary snoring Posted: 7/19/2022
- •
  Now in effect: Updated policy on power wheelchairs, vehicles, and devices Posted: 7/18/2022
- •
  Precertification requests for enhanced utilization management services for Independence Administrators Posted: 7/12/2022
- •
  Preventive Coverage of Colonoscopies Posted: 7/7/2022
- •
  Now in effect: Updates to the list of specialty drugs that will require precertification Posted: 7/6/2022
- •
  Now in effect: Updated proton beam radiation therapy policy Posted: 7/5/2022
- •
  June policy updates Posted: 7/5/2022
- •
  New update on medical policy regarding power wheelchairs, vehicles, and devices Posted: 6/23/2022
- •
  Upcoming changes to policy for wheelchair options and accessories Posted: 6/21/2022
- •
  Changes to the Direct Ship Drug Program Posted: 6/20/2022
- •
  Updates made to coverage regarding specific techniques for Uterine Fibroid Myolysis Posted: 6/6/2022
- •
  Changes to medical policy on orthopedic footwear Posted: 6/6/2022
- •
  Change to Medicare Advantage Inpatient Hospital Readmission claim payment policy Posted: 6/6/2022
- •
  May policy updates Posted: 6/2/2022
- •
  New telemedicine reimbursement rate effective June 1, 2022 Posted: 6/1/2022
- •
  Precertification process for respiratory assist devices Posted: 5/26/2022
- •
  Revised guidelines: High-Technology Radiology Services Posted: 5/26/2022
- •
  Independence introduces a new Blue High Performance Network^SM Posted: 5/11/2022
- •
  Changes to medical policies regarding Stem-Cell Therapy Posted: 5/9/2022
- •
  Surgical treatment of nails Posted: 5/5/2022
- •
  April policy updates include Intravenous Ketamine Posted: 5/3/2022
- •
  Announcing new medical policy! Psychiatric collaborative care management (CoCM) Posted: 4/29/2022
- •
  Selective photothermolysis using pulsed-dye lasers Posted: 4/20/2022
- •
  Anesthesia services for spinal pain management Posted: 4/12/2022
- •
  Independence Administrators to offer enhanced utilization management solutions through AIM and eviCore Posted: 4/7/2022
- •
  Bronchial valve placement changes Posted: 4/7/2022
- •
  Updates to the Proton Beam Radiation Therapy medical policy Posted: 4/6/2022
- •
  Now in effect: Updated preferred products for select oncology and oncology adjunct therapies Posted: 4/5/2022
- •
  Clinical Guidelines for cardiology updated Posted: 4/4/2022
- •
  March policy updates include EMG, Nerve Conduction Studies Posted: 4/4/2022
- •
  COVID-19 (Coronavirus): Prior authorizations for acute care resume Posted: 3/31/2022
- •
  Updates to the list of specialty drugs that will require precertification Posted: 3/31/2022
- •
  Updates to the medical benefit specialty drug cost-share list effective July 1, 2022 Posted: 3/31/2022
- •
  Clinical Guidelines for radiology revised Posted: 3/31/2022
- •
  Reimbursement of long-acting reversible contraceptives supplied after an obstetrical delivery Posted: 3/28/2022
- •
  Tezspire™ eligible for coverage under the medical benefit Posted: 3/24/2022
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 3/2/2022
- •
  Telemedicine reimbursement rate update Posted: 3/1/2022
- •
  Changes to the Most Cost-Effective Setting Program Posted: 2/15/2022
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 2/1/2022
- •
  Preferred products for infliximab Posted: 1/12/2022
- •
  Non-Remote and Remote Intraoperative Neurophysiological Monitoring (INM) coverage clarification Posted: 1/6/2022
- •
  Needle Electromyography (EMG) and Nerve Conduction Studies (NCS) coverage criteria changes Posted: 1/6/2022
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 1/5/2022
- •
  COVID-19 (Coronavirus): Vaccine coverage and reimbursement Posted: 1/4/2022
Medi
2021 Updates
- •
  Updated preferred products for select oncology and oncology adjunct therapies Posted: 12/29/2021
- •
  COVID-19 (Coronavirus): Urgent Care providers cost-share waiver Posted: 12/28/2021
- •
  Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo^®) coverage criteria changesPosted: 12/22/2021
- •
  Quartet is expanding behavioral services for patients Posted: 12/20/2021
- •
  Hepatoma screening initiative Posted: 12/20/2021
- •
  Change to COVID-19 vaccine billing – Medicare Advantage Posted: 12/9/2021
- •
  Changes to the Most Cost-Effective Setting Program Posted: 12/8/2021
- •
  Elzonris^® and Trogarzo^™ policies to be archived Posted: 12/6/2021
- •
  Important changes to Pepaxto^® coverage Posted: 12/6/2021
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 12/1/2021
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 11/22/2021
- •
  Updates to the list of specialty drugs that will require precertification Posted: 11/22/2021
- •
  COVID-19 (Coronavirus): Vaccine information Posted: 11/10/2021
- •
  Pegfilgrastim (Neulasta^®) and related biosimilars coverage criteria changesPosted: 11/10/2021
- •
  Assistant-at-Surgery Services reimbursement policy update Posted: 11/5/2021
- •
  Now in effect! Preferred product for injectable treprostinil Posted: 11/3/2021
- •
  COVID-19 (Coronavirus): Infusion drug treatment Posted: 10/29/2021
- •
  COVID-19 (Coronavirus): Member coverage for treatment Posted: 10/29/2021
- •
  COVID-19 (Coronavirus): Member coverage for testing Posted: 10/29/2021
- •
  Podimetrics SmartMat™ pilot begins November 1, 2021 Posted: 10/28/2021
- •
  COVID-19 (Coronavirus): Member cost-share claims processing for testing and treatment Posted: 10/28/2021
- •
  Help monitor COVID-19 patients at home with pulse oximeters Posted: 10/27/2021
- •
  COVID-19 (Coronavirus): Billing and coding for testing Posted: 10/27/2021
- •
  Ordering Synagis^® (palivizumab) for 2021-2022 RSV season Posted: 10/26/2021
- •
  Updates to the medical benefit specialty drug cost-share list effective January 1, 2022 Posted: 10/21/2021
- •
  Important updates to Independence telemedicine policy for commercial members Posted: 10/12/2021
- •
  An innovative approach to behavioral health Posted: 10/8/2021
- •
  CRNP and PA credentialing and reimbursement Posted: 10/7/2021
- •
  Reminder: Changes to reimbursement of consultation codes for commercial members Posted: 10/4/2021
- •
  COVID-19 (Coronavirus): Telemedicine services for Independence members Posted: 10/1/2021
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 9/30/2021
- •
  Radiation Therapy Clinical Guidelines – effective October 1, 2021 Posted: 9/28/2021
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 9/27/2021
- •
  Coverage for preventive PrEP services Posted: 9/20/2021
- •
  Two drugs added to the Most Cost-Effective Setting Program Posted: 9/15/2021
- •
  Expanded coverage of Shingrix for Independence commercial members Posted: 9/13/2021
- •
  Check medical policies before processing claims Posted: 9/3/2021
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 8/31/2021
- •
  Preferred product for the generic injectable treprostinil Posted: 8/10/2021
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 8/2/2021
- •
  Updated Colorectal Cancer Screening Preventive Coverage Posted: 7/27/2021
- •
  COVID-19 (Coronavirus): Pharmacologic nuclear stress testing Posted: 7/15/2021
- •
  Updated InterQual^® guidelines for 2021Posted: 7/13/2021
- •
  Aduhelm™ for treatment of Alzheimer’s disease considered experimental/investigational Posted: 7/8/2021
- •
  Now in effect! Updates to the medical benefit specialty drug cost-share list effective July 1, 2021 Posted: 7/1/2021
- •
  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 7/1/2021
- •
  Now in effect! Updates to the list of specialty drugs that require precertification Posted: 7/1/2021
- •
  COVID-19 (Coronavirus): DME requirements reinstated Posted: 7/1/2021
- •
  COVID-19 (Coronavirus): Coverage for respiratory equipment and related supplies Posted: 7/1/2021
- •
  COVID-19 (Coronavirus): Important change to commercial adult and pediatric well visit policy Posted: 7/1/2021
- •
  Update to commercial telemedicine policy Posted: 6/30/2021
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 6/29/2021
- •
  Updates to the list of specialty drugs that will require precertification Posted: 6/29/2021
- •
  Updates to the medical benefit specialty drug cost-share list effective July 1, 2021Posted: 6/29/2021
- •
  Independence Medical and Claim Payment Policy portalPosted: 6/28/2021
- •
  COVID-19 (Coronavirus): Medicare Diabetes Prevention Program Posted: 6/21/2021
- •
  COVID-19 (Coronavirus): Ground ambulance coverage for Medicare Advantage membersPosted: 5/25/2021
- •
  COVID-19 (Coronavirus): Certain DME requirements waived and clinical indication enforcement relaxed Posted: 4/27/2021
- •
  Now in effect: Changes to the Direct Ship Drug ProgramPosted: 4/15/2021
- •
  Now in effect: Two drugs added to the Most Cost-Effective Setting Program Posted: 4/8/2021
- •
  Now in effect: Preferred products for long- and short-acting colony-stimulating factorsPosted: 4/1/2021
- •
  Independence physical therapy and occupational therapy network expansionPosted: 4/1/2021
- •
  Physical therapy and occupational therapy precertification through PEAR portal Posted: 3/31/2021
- •
  NeP4V program manual updates and new FAQPosted: 3/30/2021
- •
  COVID-19 (Coronavirus): How to become a vaccinator Posted: 3/30/2021
- •
  Two drugs added to the Most Cost-Effective Setting Program Posted: 3/25/2021
- •
  Changes to the Direct Ship Drug ProgramPosted: 3/25/2021
- •
  COVID-19 (Coronavirus): Vaccine reporting requirementsPosted: 3/10/2021
- •
  COVID-19 (Coronavirus): Non-traditional providers Posted: 3/10/2021
- •
  New LTAC precertification form Posted: 3/8/2021
- •
  Enroll to be part of the COVID-19 Vaccination ProgramPosted: 2/4/2021
- •
  Reminder: eviCore Lab Management Program expanded to Medicare Advantage members Posted: 2/1/2021
- •
  Independence Administrators to delegate some precertification to eviCore Posted: 1/28/2021
- •
  Adult vaccination initiative (BCBSA Open Bed Campaign) Posted: 1/19/2021
- •
  COVID-19 (Coronavirus): Specimen collection by medical professionals Posted: 1/8/2021
- •
  Now in effect: eviCore Lab Management Program has expanded to Medicare Advantage members Posted: 1/4/2021
- •
  Now in effect: Updates to the medical benefit specialty drug cost-share list as of January 1, 2021Posted: 1/4/2021
- •
  Now in effect: Coverage changes for select injectable asthma drugsPosted: 1/4/2021
Medi
2020 Updates
- •
  Updated list of specialty drugs that require precertification now in effect Posted: 12/30/2020
- •
  Preferred products for long- and short-acting colony-stimulating factorsPosted: 12/30/2020
- •
  COVID-19 (Coronavirus): Member coverage for testing and treatment Posted: 12/29/2020
- •
  Introducing a new kidney care management program: Strive Health Kidney CarePosted: 12/10/2020
- •
  Medical policy changes for polyarticular juvenile idiopathic arthritis drugs for commercial membersPosted: 12/8/2020
- •
  Reminder: The annual Synagis^®(palivizumab) distribution programPosted: 12/7/2020
- •
  Kidney care measures for the nephrology pay for value (NeP4V) programPosted: 12/2/2020
- •
  COVID-19 (Coronavirus): Update to AIM guidelines to allow CT for diagnosis of COVID-19 pneumonia Posted: 12/2/2020
- •
  Archival of several medical policies Posted: 12/2/2020
- •
  Updated Lab Management Clinical GuidelinesPosted: 12/1/2020
- •
  ACT 81: Medical coverage for newborns for Independence membersPosted: 11/23/2020
- •
  New code added as a benefit exclusion for correcting an intraocular lensPosted: 11/5/2020
- •
  New eviCore Lab Management Program policy for Medicare Advantage membersPosted: 11/2/2020
- •
  View up-to-date policy activity on our Medical and Claim Payment Policy PortalPosted: 10/27/2020
- •
  Upcoming changes to billing requirements for deep brain stimulation Posted: 10/26/2020
- •
  Avastin^®is the preferred product for treatment of vascular endothelial growth factorPosted: 10/26/2020
- •
  Diabetic retinopathy pilot program continuesPosted: 10/15/2020
- •
  Reminder: The annual Synagis^® (palivizumab) distribution program Posted: 10/14/2020
- •
  Updated policies on musculoskeletal services: AIM guidelines for select interventional pain management and spinal and joint surgical proceduresPosted: 10/14/2020
- •
  Independence to decrease clinical update frequency for Medicare Advantage inpatient staysPosted: 10/14/2020
- •
  Independence to update telemedicine coverage in 2021 Posted: 10/2/2020
- •
  Updates to the list of specialty drugs that will require precertification Posted: 10/2/2020
- •
  Medical necessity criteria for skilled and subacute care in a Skilled Nursing Facility Posted: 10/1/2020
- •
  Updates to the medical benefit specialty drug cost-share list effective January 1, 2021Posted: 10/1/2020
- •
  Now in effect! Updated Radiation Therapy Clinical Guidelines Posted: 10/1/2020
- •
  eviCore Lab Management Program expanding to Medicare Advantage members Posted: 10/1/2020
- •
  Now in effect: Three drugs added to the Most Cost-Effective Setting ProgramPosted: 10/1/2020
- •
  Coverage changes for select injectable asthma drugs Posted: 10/1/2020
- •
  Encourage flu vaccinationsPosted: 9/25/2020
- •
  New guide for post-acute facility admissionsPosted: 9/23/2020
- •
  Introducing the nephrology pay for value (NeP4V) programPosted: 9/22/2020
- •
  Updated coverage criteria for trigger point injections without medication Posted: 9/14/2020
- •
  Annual Synagis^® (palivizumab) distribution program Posted: 9/14/2020
- •
  Three drugs to be added to the Most Cost-Effective Setting ProgramPosted: 9/1/2020
- •
  Now in effect! Updates to the list of specialty drugs that require precertification Posted: 9/1/2020
- •
  Clinical criteria and guidelines used for determinations of medically necessary coverage decisionsPosted: 8/14/2020
- •
  Updated sleep study precertification requirementsPosted: 8/7/2020
- •
  Updates to the list of specialty drugs that will require precertification as of September 1, 2020Posted: 7/31/2020
- •
  Updated InterQual^® Criteria for 2020Posted: 7/30/2020
- •
  Now in effect! Updates to the list of specialty drugs that require precertification as of July 1, 2020Posted: 7/29/2020
- •
  Now in effect: Preferred products for select oncology biosimilarsPosted: 7/9/2020
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 7/2/2020
- •
  Now in effect: Two drugs added to the Most Cost-Effective Setting ProgramPosted: 7/1/2020
- •
  COVID-19 (Coronavirus): Travel recommendations and precautionsPosted: 7/1/2020
- •
  Preferred products announced for select oncology biosimilarsPosted: 6/16/2020
- •
  Two drugs to be added to the Most Cost-Effective Setting ProgramPosted: 5/28/2020
- •
  Updates to the list of medical benefit specialty drugs that will require precertification and/or cost-share effective July 1, 2020Posted: 4/3/2020
- •
  COVID-19 (Coronavirus): Provider guidance for CHIP program membersPosted: 4/3/2020
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 3/4/2020
- •
  Avoid denials and processing delays by submitting necessary information for vendor-based utilization management precertification requestsPosted: 3/3/2020
- •
  New report: Early-onset dementia and Alzheimer’s diagnoses spikePosted: 3/2/2020
- •
  Update to the Independence response to coronavirus disease (COVID-19)Posted: 2/19/2020
- •
  Archival of policy regarding electrical stimulation and electromagnetic stimulation for the treatment of wounds Posted: 2/19/2020
- •
  Change to reimbursement criteria for office-based dermatological pathology proceduresPosted: 2/18/2020
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 2/18/2020
- •
  Preferred products announced for select oncology biosimilars Posted: 2/13/2020
- •
  Archival of policy regarding cardiac pacemaker reportingPosted: 2/10/2020
- •
  Archival of policy regarding myocardial perfusion imaging Posted: 2/3/2020
- •
  Now in effect: Seven drugs added to the Most Cost-Effective Setting Program Posted: 2/3/2020
- •
  Independence response to coronavirus (COVID-19)Posted: 1/29/2020
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 1/23/2020
- •
  Sepsis: Criteria for documenting, coding, and billing Posted: 1/23/2020
- •
  Now in effect: New policy criteria for treatment of osteoarthritis of the kneePosted: 1/16/2020
- •
  Changes to reimbursement of consultation codes for commercial members Posted: 1/15/2020
- •
  Changes to physical therapy and occupational therapy precertification requirements for Medicare Advantage members now in effectPosted: 1/15/2020
- •
  Updated list of specialty drugs that require precertification now in effectPosted: 1/2/2020
- •
  Updates to the medical benefit specialty drug cost-sharing list for 2020Posted: 1/2/2020
- •
  Now in effect: Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 1/2/2020
Medi
2019 Updates
- •
  Significant change to CMS time frames for Medicare Part B drug requests Posted: 12/30/2019
- •
  Updates to Magellan Care Guidelines for transcranial magnetic stimulation treatmentPosted: 12/30/2019
- •
  Seven drugs to be added to the Most Cost-Effective Setting Program Posted: 12/30/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 12/18/2019
- •
  Independence joins LabCorp and Wills Eye Hospital in diabetic retinopathy screening pilotPosted: 12/17/2019
- •
  Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 12/17/2019
- •
  Upcoming changes to physical therapy and occupational therapy precertification requirements for Medicare Advantage membersPosted: 12/16/2019
- •
  Self-funded groups must elect to participate in vendor-based utilization management programsPosted: 12/16/2019
- •
  Updates to the specialty drugs covered under the pharmacy benefitPosted: 12/12/2019
- •
  Proper processing of claims regarding CAR T-cell therapy for Medicare Advantage membersPosted: 12/11/2019
- •
  Updates to the medical benefit specialty drug cost-sharing list for 2020Posted: 12/3/2019
- •
  Updates to the list of specialty drugs that will require precertification Posted: 12/2/2019
- •
  Items and services always integral to the primary ambulance service for Medicare Advantage membersPosted: 12/2/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 11/21/2019
- •
  Eleven new drugs added to the Dosage and Frequency ProgramPosted: 11/15/2019
- •
  Vaccinations recommended for adult Independence membersPosted: 11/5/2019
- •
  Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 11/1/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 10/24/2019
- •
  Scheduling annual well-care visitsPosted: 10/21/2019
- •
  Reminder: Coverage criteria for the annual Synagis^® (palivizumab) distribution program Posted: 10/17/2019
- •
  Act now! Encourage adults to get flu vaccinationsPosted: 10/10/2019
- •
  Coverage of interprofessional internet consultation for Medicare Advantage membersPosted: 10/8/2019
- •
  Introducing the new PEAR portal for managing clinical and financial activitiesPosted: 10/4/2019
- •
  New policy criteria for treatment of osteoarthritis of the kneePosted: 10/3/2019
- •
  Updated policies for Direct Access to OB/GYN servicesPosted: 10/2/2019
- •
  Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 10/2/2019
- •
  Updates to the list of specialty drugs that will require precertification Posted: 10/2/2019
- •
  Upcoming changes to physical therapy and occupational therapy precertification requirements for Medicare Advantage membersPosted: 10/2/2019
- •
  Updates to the medical benefit specialty drug cost-sharing list for 2020Posted: 9/30/2019
- •
  Expanding preventive coverage of HPV vaccinePosted: 9/27/2019
- •
  Coverage update for surgical and minimally invasive treatments for urinary outlet obstruction due to BPHPosted: 9/27/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 9/24/2019
- •
  Save the date! Pennsylvania will host Medication-Assisted Treatment Regional Summits this fallPosted: 9/19/2019
- •
  Important information! CRNP contracting and credentialingPosted: 9/17/2019
- •
  Coverage criteria for the annual Synagis^® (palivizumab) distribution program Posted: 9/9/2019
- •
  AIM to allow pre-service review for arterial ultrasounds Posted: 9/4/2019
- •
  Now in effect: New claim payment policies for multiple therapies Posted: 9/3/2019
- •
  Reminder: Tysabri^® added to the Most Cost-Effective Setting Program Posted: 9/3/2019
- •
  Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 9/3/2019
- •
  Changes to the Most Cost-Effective Setting Program: Pediatric exceptionPosted: 8/27/2019
- •
  Skilled nursing, subacute, and inpatient rehabilitation facility admission guidelinesPosted: 8/23/2019
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/21/2019
- •
  Changes to the annual Synagis^® (palivizumab) distribution program Posted: 8/9/2019
- •
  New claim payment policies for multiple therapies Posted: 8/1/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 7/22/2019
- •
  Updated InterQual^® Criteria for 2019Posted: 7/15/2019
- •
  Radiation Therapy Clinical Guidelines updated as of July 1, 2019Posted: 7/1/2019
- •
  Specialty drugs that require precertification as of July 1, 2019Posted: 7/1/2019
- •
  The medical benefit specialty drug cost-sharing list updated as of July 1, 2019Posted: 7/1/2019
- •
  Clinical Appropriateness Guidelines for Radiology updated as of July 1, 2019Posted: 7/1/2019
- •
  Clinical Appropriateness Guidelines for Arterial Ultrasound updated as of July 1, 2019Posted: 7/1/2019
- •
  Clinical Appropriateness Guidelines for Advanced Imaging of the Heart updated as of July 1, 2019Posted: 7/1/2019
- •
  New Dosage and Frequency Program webpage now available Posted: 6/21/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 6/20/2019
- •
  Updated: New drugs added to the Dosage and Frequency Program Posted: 6/5/2019
- •
  Updates to the list of specialty drugs that will require precertification Posted: 6/3/2019
- •
  Tysabri^® added to the Most Cost-Effective Setting ProgramPosted: 5/30/2019
- •
  Preventive coverage of exercise interventions for the prevention of falls for commercial membersPosted: 5/22/2019
- •
  Measles disease outbreak and vaccine coverage for Independence commercial membersPosted: 5/20/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 5/20/2019
- •
  Cost-sharing and billing requirements for preventive colonoscopy and flexible sigmoidoscopyPosted: 5/6/2019
- •
  Updates to the medical benefit specialty drug cost-sharing listPosted: 5/1/2019
- •
  Preferred Skilled Nursing Facility Program now available for eligible Independence Medicare Advantage membersPosted: 5/1/2019
- •
  Clinical Appropriateness Guidelines for Arterial Ultrasound to be updatedPosted: 5/1/2019
- •
  Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 5/1/2019
- •
  Clinical Appropriateness Guidelines for Advanced Imaging of the Heart to be updatedPosted: 5/1/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 4/22/2019
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 4/22/2019
- •
  FDA releases statement on the efficacy of Lartruvo^®Posted: 4/12/2019
- •
  Self-funded groups must elect to participate in vendor-based utilization management programsPosted: 4/8/2019
- •
  Mumps disease outbreak and vaccine coverage for Independence commercial membersPosted: 4/5/2019
- •
  Updates to Direct Ship Drug Program listPosted: 4/4/2019
- •
  Reminder: Updated reimbursement policies for CRNPs and PAs Posted: 4/3/2019
- •
  Claim reprocessing for multiple procedure payment reductions on certain diagnostic servicesPosted: 3/28/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 3/25/2019
- •
  Preventive coverage of spinal muscular atrophy screening Posted: 3/18/2019
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 2/22/2019
- •
  New drugs to be added to the Dosage and Frequency Program Posted: 2/18/2019
- •
  Updates to the list of specialty drugs that require precertification Posted: 2/15/2019
- •
  Four drugs added to the Dosage and Frequency Program Posted: 1/25/2019
- •
  Four drugs added to Most Cost-Effective Setting Program Posted: 1/25/2019
- •
  Reminder: Updated credentialing requirements for CRNPs and PAsPosted: 1/24/2019
- •
  New acupuncture benefit and network now in effectPosted: 1/22/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 1/22/2019
- •
  Changes coming to application of Modifier 59 in 2019Posted: 1/11/2019
- •
  Changes to the management of CAPS drugs now in effectPosted: 1/7/2019
- •
  Updated list of specialty drugs that require precertification now in effectPosted: 1/3/2019
- •
  Frequency limit established for trigger point injections for myofascial pain syndromePosted: 1/3/2019
- •
  Updated medical benefit specialty drug cost-sharing list now in effectPosted: 1/3/2019
Medi
2018 Updates
- •
  New policy on pediatric intensive day feeding programPosted: 12/28/2018
- •
  Introducing a new palliative care program Posted: 12/20/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 12/19/2018
- •
  Outbreak of life-threatening coagulopathy associated with synthetic cannabinoids usePosted: 12/14/2018
- •
  Reminder: New acupuncture benefit and networkPosted: 12/6/2018
- •
  Reminder: Updates to the list of specialty drugs that will require precertification Posted: 12/5/2018
- •
  Reminder: Updates to the medical benefit specialty drug cost-sharing listPosted: 12/5/2018
- •
  Updated policies for facility reporting of observation servicesPosted: 11/30/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 11/26/2018
- •
  Four drugs added to Most Cost-Effective Setting ProgramPosted: 11/5/2018
- •
  Updates to the list of specialty drugs that will require precertification Posted: 11/1/2018
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 11/1/2018
- •
  Reminder: Updates to the medical benefit specialty drug cost-sharing listPosted: 11/1/2018
- •
  Updated Clinical Appropriateness Guidelines for Radiology now availablePosted: 10/29/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 10/18/2018
- •
  Important news about the annual Synagis^® (palivizumab) distribution program Posted: 10/17/2018
- •
  Changes to the seasonal influenza vaccine recommendations for 2017 – 2018 Posted: 10/9/2018
- •
  New acupuncture benefit and networkPosted: 10/3/2018
- •
  New Most Cost-Effective Setting Program webpagePosted: 10/3/2018
- •
  Updated Radiation Therapy Clinical Guidelines now availablePosted: 10/1/2018
- •
  Changes to reimbursement of anesthesia physical status modifiersPosted: 10/1/2018
- •
  Changes to the management of CAPS drugsPosted: 10/1/2018
- •
  Updates to the medical benefit specialty drug cost-sharing listPosted: 9/28/2018
- •
  Updates to the list of specialty drugs that will require precertification Posted: 9/25/2018
- •
  Updated policy on proton beam radiation therapyPosted: 9/19/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 9/18/2018
- •
  Update to multiple procedure payment reductions on certain diagnostic servicesPosted: 9/14/2018
- •
  Annual Synagis^® (palivizumab) distribution program approaching Posted: 9/13/2018
- •
  Four drugs to be added to the Dosage and Frequency ProgramPosted: 9/11/2018
- •
  Reimbursement for observation services with an ER visitPosted: 9/6/2018
- •
  Updated policies on aqueous shunts, microstents, viscocanalostomy, and canaloplasty for the treatment of glaucoma Posted: 9/5/2018
- •
  Upcoming change to the clinical review of Home Health servicesPosted: 8/31/2018
- •
  New precertification requirement for Onpattro^TM (patisiran) Posted: 8/17/2018
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/16/2018
- •
  Revised guidelines for colorectal cancer screening for average-risk-level adultsPosted: 8/9/2018
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 8/8/2018
- •
  Updated Clinical Appropriateness Guidelines for RadiologyPosted: 8/8/2018
- •
  Reminder: Comprehensive Care ProgramPosted: 8/2/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 7/18/2018
- •
  Updated InterQual^® Criteria for 2018Posted: 7/16/2018
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 7/10/2018
- •
  Updates to the medical benefit specialty drug cost-sharing list now in effectPosted: 7/2/2018
- •
  Four drugs to be added to Most Cost-Effective Setting ProgramPosted: 6/25/2018
- •
  Updated coverage positions on zoster and hepatitis B vaccines for commercial membersPosted: 6/18/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 6/18/2018
- •
  Reminder: Updates to the list of specialty drugs that require precertification Posted: 6/15/2018
- •
  Updated policies on SCODIPosted: 6/13/2018
- •
  Updates to Direct Ship Drug Program request formsPosted: 6/11/2018
- •
  Updated information regarding our Cardiology Utilization Management ProgramPosted: 6/11/2018
- •
  Reminder: Changes to reimbursement of consultation codes for Medicare Advantage HMO and PPO membersPosted: 6/4/2018
- •
  Site of service changes and new coverage option for Benlysta^® now in effect Posted: 6/1/2018
- •
  Updates to the medical benefit specialty drug cost-sharing listPosted: 5/31/2018
- •
  Billing of date ranges for DME and specialty pharmacy Posted: 5/24/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 5/18/2018
- •
  Updates to the list of specialty drugs that require precertificationPosted: 5/10/2018
- •
  Changes to reimbursement of consultation codes for Medicare Advantage HMO and PPO membersPosted: 5/3/2018
- •
  Reminder: Site of service changes and new coverage option for Benlysta^® Posted: 5/1/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 4/20/2018
- •
  Code update for home prothrombin time monitoringPosted: 4/13/2018
- •
  Code update for TENS and associated suppliesPosted: 4/6/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 3/14/2018
- •
  Reminder: Home-based sleep testing now requires precertification Posted: 3/2/2018
- •
  Reminder: Updates to the list of specialty drugs that require precertificationPosted: 3/2/2018
- •
  Reminder: Delegation of precertification for interventional pain management services to AIM now in effectPosted: 3/1/2018
- •
  Site of service changes and new coverage option for Benlysta^® Posted: 3/1/2018
- •
  Updated policy on DME and consumable medical suppliesPosted: 2/23/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 2/15/2018
- •
  Changes for pathologists reporting services in the office settingPosted: 2/13/2018
- •
  Reminder: Delegation of precertification for interventional pain management services to AIMPosted: 2/12/2018
- •
  Updates to the medical benefit specialty drug cost-sharing list for 2018Posted: 2/6/2018
- •
  Updates to the list of specialty drugs that require precertificationPosted: 1/30/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 1/16/2018
- •
  Coverage position changes for endovenous mechanochemical ablationPosted: 1/4/2018
- •
  Update to the nebulizers policy to include inhalation solutionsPosted: 1/4/2018
- •
  Announcing soft launch period for new Musculoskeletal Utilization Management ProgramPosted: 1/3/2018
- •
  Coverage changes for office-based pathology servicesPosted: 1/3/2018
- •
  Updated policies for Mohs' micrographic surgery Posted: 1/2/2018
Medi
2017 Updates
- •
  Upcoming changes to billing requirements for neuropsychological testing for neurologically based conditionsPosted: 12/27/2017
- •
  Precertification requirement for fractional flow reserve added to AIM Radiology Guidelines Posted: 12/22/2017
- •
  Updates to the list of specialty drugs that will require precertificationPosted: 12/21/2017
- •
  Reminder: Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 12/18/2017
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 12/15/2017
- •
  Update regarding InterQual^® guidelines for 2017Posted: 12/15/2017
- •
  Reminder of utilization management programs effective January 2018 and delegation of precertification review to AIM Posted: 12/15/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/14/2017
- •
  Precertification of spinal bone growth stimulators Posted: 12/4/2017
- •
  Closing of pathology network for new office-based pathology providersPosted: 12/1/2017
- •
  Home-based sleep testing to require precertification Posted: 12/1/2017
- •
  Announcing the expansion of Independence’s Musculoskeletal Utilization Management Program to include services for interventional pain management Posted: 12/1/2017
- •
  Reminder: New Cardiology Utilization Management Program through AIMPosted: 11/28/2017
- •
  Reminder: New utilization management program for musculoskeletal servicesPosted: 11/28/2017
- •
  Update regarding InterQual^® guidelines for 2017Posted: 11/20/2017
- •
  Reminder: Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 11/17/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 11/17/2017
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 11/15/2017
- •
  New policies for laboratory-based vestibular function testingPosted: 11/15/2017
- •
  Updates to our policies on presumptive and definitive drug testing in substance abuse and pain management treatmentsPosted: 11/15/2017
- •
  Updates to the list of specialty drugs that will require precertificationPosted: 11/14/2017
- •
  Changes to recent Notifications regarding precertification requirements for CINV/antiemetic agentsPosted: 11/14/2017
- •
  Updated policies on the treatment of glaucomaPosted: 11/1/2017
- •
  Now in effect: Preferred product for enzyme replacement to treat Gaucher's disease Posted: 10/26/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 10/25/2017
- •
  Important news about the annual Synagis^® (palivizumab) distribution program Posted: 10/23/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/18/2017
- •
  Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 10/16/2017
- •
  Changes to management of subcutaneous immunoglobulin now in effectPosted: 10/5/2017
- •
  Announcing Cardiology Utilization Management Program through AIMPosted: 10/3/2017
- •
  Announcing new utilization management program for musculoskeletal servicesPosted: 10/3/2017
- •
  Upcoming changes to specialty drugs requiring precertificationPosted: 10/2/2017
- •
  Select chemotherapy-induced nausea and vomiting drugs to require precertificationPosted: 10/2/2017
- •
  New precertification requirement for CAR T-cell therapyPosted: 9/22/2017
- •
  Updated policies on cast and splint applications and suppliesPosted: 9/21/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 9/21/2017
- •
  $0 copays on preferred brand diabetic test strips and glucose meters for Medicare Advantage membersPosted: 9/19/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 9/18/2017
- •
  Updates to our Most Cost-Effective Setting Program now in effectPosted: 9/7/2017
- •
  Annual Synagis^® (palivizumab) distribution program approaching Posted: 9/5/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 8/22/2017
- •
  Reminder: Seven drugs to be added to Most Cost-Effective Setting ProgramPosted: 8/17/2017
- •
  Get up-to-date health notifications for your patients Posted: 8/16/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/11/2017
- •
  Independence initiatives to combat opioid misuse and abusePosted: 8/7/2017
- •
  Upcoming changes to billing requirements for septoplastyPosted: 8/3/2017
- •
  Preferred product designated for enzyme replacement to treat Gaucher's diseasePosted: 7/26/2017
- •
  Updates to the policies on Modifier 25 reporting and reimbursementPosted: 7/24/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 7/20/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 7/17/2017
- •
  Updates to presumptive and definitive drug testing in substance abuse and pain management treatments Posted: 7/7/2017
- •
  Reminder: Seven drugs to be added to Most Cost-Effective Setting ProgramPosted: 7/6/2017
- •
  Updated billing requirements for preventive colonoscopy and flexible sigmoidoscopyPosted: 7/5/2017
- •
  Updated policies on toe nail debridementPosted: 6/29/2017
- •
  Medical codes for services that require precertificationPosted: 6/28/2017
- •
  Updated InterQual^® guidelines for 2017Posted: 6/21/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 6/19/2017
- •
  Precertification requirements for Spinraza™ (nusinersen) and Bavencio^® (avelumab) Posted: 6/15/2017
- •
  Updated Lab Management Clinical GuidelinesPosted: 6/13/2017
- •
  Combined policies for abdominoplasty, panniculectomy, abdominal lipectomy, and other excisions of redundant skin Posted: 6/7/2017
- •
  Update to our Radiation Treatment of Breast Carcinoma guideline Posted: 6/1/2017
- •
  New policies for autonomic nervous system testingPosted: 5/26/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 5/19/2017
- •
  Seven drugs to be added to Most Cost-Effective Setting ProgramPosted: 5/16/2017
- •
  Clear Claim Connection^™ transaction to be removed from NaviNet^®Posted: 5/9/2017
- •
  Reminder: Our policies on inpatient hospital readmissionsPosted: 5/4/2017
- •
  Updated policies on Modifier 25 reporting and reimbursementPosted: 5/1/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 5/1/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 4/20/2017
- •
  Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)Posted: 4/14/2017
- •
  Four drugs added to the Dosage and Frequency ProgramPosted: 4/13/2017
- •
  New policies for Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or AntiepilepticsPosted: 3/28/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 3/13/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 2/6/2017
- •
  2016 SOAP Progress Note submission deadline for the ePASS^® incentive programPosted: 2/1/2017
- •
  Important: Extreme danger posed by carfentanilPosted: 1/18/2017
- •
  Neulasta^®: Updates to precertification and setting requirements and coverage options now in effectPosted: 1/11/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 1/10/2017
- •
  Billing guidelines for leuprolide acetate (Lupron Depot^® and Eligard^®)Posted: 1/6/2017
- •
  Reminder: Changes to precertification requirements for 2017Posted: 1/6/2017
- •
  Reminder: $0 copays on preferred brand diabetic test strips and glucose monitors for Medicare Advantage membersPosted: 1/4/2017
Medi
2016 Updates
- •
  Introducing the Comprehensive Care ProgramPosted: 12/9/2016
- •
  Reminder: Cost-sharing and billing requirements for Preventive colorectal cancer screeningPosted: 12/1/2016
- •
  Reminder: $0 copays on preferred diabetic supplies for Medicare Advantage membersPosted: 12/1/2016
- •
  Reminder: Neulasta^®: Updates to precertification requirements, sites of service, and coverage optionsPosted: 12/1/2016
- •
  Reminder: Upcoming changes to precertification requirements for 2017Posted: 12/1/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/1/2016
- •
  Reminder: Upcoming changes to medical benefit specialty drug cost-sharing for 2017Posted: 12/1/2016
- •
  Cost-sharing and billing requirements for Preventivecolorectal cancer screeningPosted: 10/31/2016
- •
  Neulasta^®: Updates to precertification requirements, sites of service, and coverage optionsPosted: 10/31/2016
- •
  Coverage for transgender servicesPosted: 10/31/2016
- •
  Reminder: $0 copays on preferred diabetic supplies for Medicare Advantage membersPosted: 10/31/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/31/2016
- •
  Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 10/3/2016
- •
  Updated policy for anesthesia servicesPosted: 10/3/2016
- •
  Upcoming changes to drug precertification requirements for 2017Posted: 10/3/2016
- •
  Coverage position changes for select medical servicesPosted: 10/3/2016
- •
  Important news about the annual Synagis^® (palivizumab) distribution programPosted: 10/3/2016
- •
  Upcoming changes to medical benefit specialty drug cost-sharing for 2017Posted: 10/3/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/3/2016
- •
  Upcoming precertification changes for outpatient, non-emergent radiation therapy servicesPosted: 10/3/2016
- •
  Upcoming changes to precertification requirements for Cologuard^™ and NIPT/NIPSPosted: 10/3/2016
- •
  New Pennsylvania Prescription Drug Monitoring Programsystem now availablePosted: 10/3/2016
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 9/1/2016
- •
  Why health plans partner with vendors for Personal Health VisitsPosted: 8/31/2016
- •
  Changes to our ePASS^® incentive opportunity for professional providersPosted: 8/31/2016
- •
  Changes to the seasonal influenza vaccine recommendations for 2016-2017Posted: 8/31/2016
- •
  Annual Synagis^® (palivizumab) distribution program approachingPosted: 8/31/2016
- •
  Injectable hyaluronate acid products removed from the Direct Ship Drug ProgramPosted: 8/31/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/31/2016
- •
  Updated policies for Always Bundled Procedure CodesPosted: 7/29/2016
- •
  New policies for Modifier 53: Discontinued ProcedurePosted: 7/29/2016
- •
  Coverage requirements for applied behavioral analysis for the treatment of autism spectrum disordersPosted: 7/29/2016
- •
  Upcoming changes to 2016 ePASS^® incentive opportunityPosted: 7/29/2016
- •
  Upcoming coverage position changes for certain laboratory testsPosted: 7/29/2016
- •
  Vitamin D testing policies now in effectPosted: 7/29/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 7/29/2016
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests now in effectPosted: 7/29/2016
- •
  Updates to policies pertaining to nerve conduction studies and needle electromyographyPosted: 6/30/2016
- •
  Yervoy^® being added to Dosing and Frequency ProgramPosted: 6/30/2016
- •
  Updated InterQual^® guidelines for 2016Posted: 6/30/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 6/30/2016
- •
  Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests now in effect Posted: 6/30/2016
- •
  Recent updates to Direct Ship Drug Program Posted: 6/1/2016
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 6/1/2016
- •
  Upcoming training for precertification of certain genetic/genomic tests through eviCorePosted: 6/1/2016
- •
  Update on appropriate use of vitamin D testingPosted: 4/29/2016
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 4/29/2016
- •
  Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 4/29/2016
- •
  Precertification for diagnostic imaging servicesPosted: 4/29/2016
- •
  Reminder: Clinical Relationship Logic and Code-to-Code Edits Posted: 3/31/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 3/31/2016
- •
  Precertification approval email notifications to be offered by eviCore Posted: 3/31/2016
- •
  New utilization management program for genetic/genomic testing and certain molecular analyses Posted: 3/31/2016
- •
  Criteria for endometrial ablationPosted: 2/29/2016
- •
  Coverage for Autism Spectrum DisordersPosted: 2/29/2016
- •
  2016 ePASS^® incentive opportunity for professional providers Posted: 2/29/2016
- •
  Reminder: New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusion Posted: 2/29/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 2/29/2016
- •
  Telemedicine solutions for Independence commercial members Posted: 1/29/2016
- •
  Reminder: Independence medical record requests and ePASS^® submissions now using EFT for payments Posted: 1/29/2016
- •
  New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusionPosted: 1/29/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 1/29/2016
Medi
2015 Updates
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/30/2015
- •
  Reminder: Changes to precertification requirements for 2016 Posted: 12/30/2015
- •
  Precertification changes for non-emergent outpatient radiation therapy services Posted: 12/30/2015
- •
  Upcoming changes in coverage for intrauterine devices Posted: 12/1/2015
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/1/2015
- •
  Update on coverage for digital breast tomosynthesisPosted: 12/1/2015
- •
  Upcoming changes to precertification requirements for 2016 Posted: 12/1/2015
- •
  Reminder: Upcoming changes to medical benefit specialty drug cost-sharing for 2016 Posted: 12/1/2015
- •
  Introducing telemedicine primary care for our commercial membersPosted: 12/1/2015
- •
  Independence medical record requests and ePASS^® submissions now using EFT for payments Posted: 12/1/2015
- •
  Reminder: Upcoming changes to drug precertification requirements for 2016 Posted: 10/30/2015
- •
  Appropriate use of vitamin D testing Posted: 10/30/2015
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/30/2015
- •
  Direct Ship Drug Program updates Posted: 10/1/2015
- •
  Important news about the annual Synagis^® (palivizumab) distribution program Posted: 10/1/2015
- •
  Upcoming changes to medical benefit specialty drug cost-sharing for 2016 Posted: 10/1/2015
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 10/1/2015
- •
  Upcoming changes to drug precertification requirements for 2016Posted: 10/1/2015
- •
  Annual Synagis^® (palivizumab) distribution program approaches Posted: 9/1/2015
- •
  Chiropractic services policy updatePosted: 9/1/2015
- •
  Reminder: Coverage for injectable drugs that reduce the risk of preterm birthPosted: 9/1/2015
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 9/1/2015
- •
  View up-to-date medical and claim payment policy activity on the Medical Policy Portal Posted: 7/31/2015
- •
  Obtaining precertification for non-emergent radiation therapy services through NaviNet^®Posted: 7/2/2015
- •
  Clarifying member cost-share amounts for medical benefit drugsPosted: 7/2/2015
- •
  Reminder: Use –X{EPSU} modifiers to report separate, distinct, or independent non-E&M services on the same dayPosted: 7/2/2015
- •
  View up-to-date medical and claim payment policy activity on the Medical Policy Portal Posted: 7/2/2015
- •
  Medical and claim payment policy activity posted from April 25 – May 22, 2015 Posted: 6/1/2015
- •
  Gender reassignment surgery claims for Medicare Advantage membersPosted: 6/1/2015
- •
  New medical policy criteria for commercial members in treatment for osteoarthritis of the kneePosted: 6/1/2015
- •
  Updated InterQual^® guidelines for 2015Posted: 6/1/2015
- •
  CareCore's radiation therapy criteria now in effectPosted: 5/1/2015
- •
  Medical and claim payment policy activity posted from March 24 – April 24, 2015 Posted: 5/1/2015
- •
  Changes to the Direct Ship Injectables Program Posted: 5/1/2015
- •
  NaviNet^® to provide direct access link to CareCore's provider portalPosted: 4/1/2015
- •
  Medical and claim payment policy activity posted from February 21 – March 23, 2015 Posted: 4/1/2015
- •
  Medical and claim payment policy activity posted from January 24 – February 20, 2015Posted: 3/2/2015
- •
  Clarification: Injectable hyaluronate acid products being removed from the Direct Ship Injectables ProgramPosted: 3/2/2015
- •
  Non-emergent outpatient radiation therapy to be reviewed for medical necessityPosted: 3/2/2015
- •
  New changes to our ePASS^® incentive opportunity for professional providers Posted: 1/30/2015
- •
  Medical and claim payment policy activity posted from December 20, 2014 – January 23, 2015Posted: 1/30/2015
- •
  Precertification and compliance monitoring for PAP machines and suppliesPosted: 1/30/2015
Medi
2014 Updates
- •
  Medicare Advantage HMO and PPO policies now in effect Posted: 12/30/2014
- •
  New codes for digital breast tomosynthesisPosted: 12/30/2014
- •
  Changes to the experimental/investigational services policies effective January 1, 2015Posted: 12/30/2014
- •
  Precertification requirements for FEP members for BRCA testing and outpatient servicesPosted: 12/30/2014
- •
  Download the latest precertification requirement list Posted: 12/30/2014
- •
  Medical and claim payment policy activity posted from November 21 – December 19, 2014 Posted: 12/30/2014
- •
  Injectable hyaluronate acid products being removed from the Direct Ship Injectables ProgramPosted: 12/30/2014
- •
  Reminder: Precertification requirements for DME providers are now in effectPosted: 12/30/2014
- •
  Precertification requirement for outpatient echocardiography services for Medicare Advantage HMO and PPO members now in effect Posted: 12/30/2014
- •
  Precertification requirement for non-emergent outpatient radiation therapy now in effect Posted: 12/30/2014
- •
  Presumptive and definitive drug testingPosted: 12/1/2014
- •
  Medical and claim payment policy activity postedOctober 25 – November 20, 2014Posted: 12/1/2014
- •
  Upcoming policy on transcutaneous electrical nerve stimulators and associated suppliesPosted: 12/1/2014
- •
  Reminder: Upcoming changes to precertification requirements for medical benefit drugsPosted: 12/1/2014
- •
  Reminder: Upcoming changes to our precertificationprocess for outpatient echocardiography services forMedicare Advantage HMO and PPO membersPosted: 12/1/2014
- •
  Reminder: Precertification requirements for DME providersgo into effect January 1, 2015Posted: 12/1/2014
- •
  Reminder: Precertification requirement for non-emergent outpatient radiation therapy starts January 1, 2015Posted: 12/1/2014
- •
  Precertification requirements for outpatient services for FEP membersPosted: 10/31/2014
- •
  Medical and claim payment policy activity posted from September 26 – October 24, 2014 Posted: 10/31/2014
- •
  Upcoming changes to precertification requirementsPosted: 10/1/2014
- •
  Recent changes to our ePASS^® incentive opportunity for professional providers Posted: 10/1/2014
- •
  Reminder: Receiving infliximab (Remicade^®) in cost-effective settingsPosted: 10/1/2014
- •
  Upcoming change to Multiple Procedure Payment Reduction guidelines for certain diagnostic servicesPosted: 10/1/2014
- •
  Upcoming changes to medical policies on spinal injectionsPosted: 10/1/2014
- •
  New Medicare Advantage HMO and PPO policy notifications now available Posted: 10/1/2014
- •
  Medical and claim payment policy activity posted from August 23 – September 25, 2014 Posted: 10/1/2014
- •
  New coverage criteria for repository corticotropin (H.P. Acthar^® Gel Injection) Posted: 10/1/2014
- •
  Important news about the annual Synagis^® (palivizumab) distribution programPosted: 10/1/2014
- •
  New precertification requirements for DME providers Posted: 10/1/2014
- •
  Upcoming changes to precertification requirements for outpatient radiation therapyPosted: 10/1/2014
- •
  Upcoming changes to our precertification process for outpatient echocardiography services for Medicare Advantage HMO and PPO members Posted: 10/1/2014
- •
  Medicare Advantage HMO and PPO policies and clinical relationship logic to undergo changes Posted: 8/28/2014
- •
  Medical and claim payment policy activity posted from July 26 – August 22, 2014 Posted: 8/28/2014
- •
  Clarification of Medical Foods policyPosted: 8/28/2014
- •
  Choosing a safe, cost-effective setting for injectable and infusion therapy drugs Posted: 8/28/2014
- •
  Annual Synagis^® (palivizumab) distribution program approaches Posted: 8/28/2014
- •
  Reminder: Upcoming changes to Medicare Advantage HMOand PPO policies and clinical relationship logicPosted: 7/31/2014
- •
  Medical and claim payment policy activity posted from June 25 – July 25, 2014 Posted: 7/31/2014
- •
  Upcoming changes to Medicare Advantage policies and clinical relationship logicPosted: 7/1/2014
- •
  Referring members for genetic testingPosted: 7/1/2014
- •
  Revision to draft Medical Policy #02.01.01c: Home Health Care ServicesPosted: 7/1/2014
- •
  Cost-effective treatment options for infliximab (Remicade^®)Posted: 7/1/2014
- •
  Medical and claim payment policy activity posted from May 26 – June 24, 2014Posted: 7/1/2014
- •
  Medical and claim payment policy activity posted from April 26 – May 25, 2014Posted: 5/30/2014
- •
  Changes to our ePASS^® incentive opportunity for professional providersPosted: 5/1/2014
- •
  Patient access for laboratory services and new LabCorp PSCsPosted: 5/1/2014
- •
  Policy updates regarding face-to-face encounter requirementsPosted: 5/1/2014
- •
  Medical and claim payment policy activity posted from March 26 – April 25, 2014Posted: 5/1/2014
- •
  Changes to our precertification process for outpatient echocardiography services now in effectPosted: 5/1/2014
- •
  Medical policy changes for rheumatoid arthritis drugs for commercial membersPosted: 3/31/2014
- •
  Medical and claim payment policy activity posted from February 26 – March 25, 2014Posted: 3/31/2014
- •
  Documentation requirements for DME servicesPosted: 2/28/2014
- •
  Medical and claim payment policy activity posted from January 26 – February 25, 2014Posted: 2/28/2014
- •
  Additional information now available for medical and claim payment policiesPosted: 2/26/2014
- •
  Medical and claim payment policy activity posted as of January 25, 2014Posted: 1/31/2014
- •
  Specialists needed to assist in developing medical policiesPosted: 1/31/2014
- •
  Upcoming changes to our precertification process for outpatient echocardiography servicesPosted: 1/31/2014
- •
  Updated policy for interstitial continuous glucose monitoring systemsPosted: 1/9/2014
- •
  Download the latest precertification requirement listPosted: 1/9/2014
- •
  Policy notifications posted as of December 30, 2013Posted: 1/9/2014
Medi
2013 Updates
- •
  Coverage for certain surgical proceduresPosted: 12/2/2013
- •
  Reminder: Updates to precertification requirements effective January 1, 2014Posted: 12/2/2013
- •
  Policy notifications posted as of November 25, 2013Posted: 12/2/2013
- •
  Coverage for injectable drugs that reduce the risk of preterm birthPosted: 12/2/2013
- •
  Changes to sleep study precertification requirements for Medicare Advantage HMO and PPO membersPosted: 12/2/2013
- •
  Policy notifications posted as of October 30, 2013Posted: 11/1/2013
- •
  BriovaRx^TM selected as exclusive specialty pharmacy provider for prescription drug benefitPosted: 11/1/2013
- •
  Policy notifications posted as of September 27, 2013Posted: 10/2/2013
- •
  Updates to precertification requirements effective January 1, 2014Posted: 10/2/2013
- •
  Changes to medical policy for self-injectable drugsPosted: 10/2/2013
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 10/2/2013
- •
  Provide Medicare Advantage HMO and PPO members notice of noncovered/excluded services and member payment responsibilityPosted: 8/29/2013
- •
  Policy notifications posted as of August 29, 2013Posted: 8/29/2013
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 8/29/2013
- •
  Changes to sleep study precertification requirements now in effectPosted: 8/29/2013
- •
  Coverage of Influenza Vaccine for 2013-2014 Posted: 8/13/2013
- •
  Policy notifications posted as of July 31, 2013Posted: 8/1/2013
- •
  Upcoming changes to the enforcement of medical and claim payment policyPosted: 8/1/2013
- •
  New resources available for medical specialty drugsPosted: 8/1/2013
- •
  Reminder: An incentive opportunity for professional providersPosted: 7/1/2013
- •
  ClaimCheck^® upgrade and edit clarificationPosted: 7/1/2013
- •
  Policy notifications posted as of June 28, 2013Posted: 7/1/2013
- •
  Updated policy for intraoperative neurophysiological monitoringPosted: 7/1/2013
- •
  Transitional care management servicesPosted: 6/7/2013
- •
  An incentive opportunity for professional providersPosted: 5/31/2013
- •
  ACEI/ARB therapy benefits for hypertensive patients who have diabetesPosted: 5/31/2013
- •
  Policy notifications as of May 29, 2013Posted: 5/31/2013
- •
  Change to anesthesia claims policyPosted: 5/31/2013
- •
  Choosing a safe, cost-effective setting for injectable and infusion therapy drugsPosted: 5/31/2013
- •
  Updated InterQual^® guidelines for 2013Posted: 5/31/2013
- •
  Upcoming changes to our medical policy on sleep disorder testingPosted: 5/31/2013
- •
  Updated policy for artificial intervertebral disc insertionPosted: 5/1/2013
- •
  No member cost-sharing for breast pumpsPosted: 5/1/2013
- •
  In-home assessments of high-risk membersPosted: 5/1/2013
- •
  Policy notifications posted as of April 26, 2013Posted: 5/1/2013
- •
  Changes to preferred products to treat osteoarthritis of the kneePosted: 5/1/2013
- •
  Policy notifications posted as of March 28, 2013Posted: 3/28/2013
- •
  ICD-10 codes now available in medical and claim payment policiesPosted: 3/28/2013
- •
  Specialists needed to assist in developing medical policiesPosted: 3/25/2013
- •
  Voluntary recall of all lots of OMONTYS^® (peginesatide) InjectionPosted: 3/7/2013
- •
  Upcoming changes to our home oxygen therapy policyPosted: 3/1/2013
- •
  Policy notifications posted as of February 28, 2013Posted: 3/1/2013
- •
  Online tool helps practices become a Patient-Centered Medical HomePosted: 2/1/2013
- •
  Policy notifications posted as of January 29, 2013Posted: 2/1/2013
Medi
2012 Updates
- •
  Policy notifications posted as of December 21, 2012Posted: 12/28/2012
- •
  New report available for primary care practicesPosted: 12/28/2012
- •
  New policy for athletic pubalgia effective March 5, 2013Posted: 12/28/2012
- •
  Policy notifications posted as of November 30, 2012Posted: 11/30/2012
- •
  Reminder: Coverage change for Plan B One-Step^® (Levonorgestrel, Next Choice^®)Posted: 11/30/2012
- •
  Health care reform: Expansion of 100 percent coverage for women’s preventive health servicesPosted: 11/30/2012
- •
  Updated policy for Never Events and Preventable Adverse EventsPosted: 11/30/2012
- •
  Policy notifications posted as of October 26, 2012Posted: 11/1/2012
- •
  Policy reminder regarding utilization review decisionsPosted: 11/1/2012
- •
  Vaccination coverage for Medicare Advantage HMO and PPO membersPosted: 11/1/2012
- •
  Coverage change for Plan B One Step^® (Levonorgestrel, Next Choice^®)Posted: 9/28/2012
- •
  Policy notifications posted as of September 21, 2012Posted: 9/28/2012
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 9/28/2012
- •
  Policy notifications posted as of August 31, 2012Posted: 8/31/2012
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 8/31/2012
- •
  Updated AIM clinical guidelinesPosted: 8/31/2012
- •
  Coverage of Influenza Vaccine for 2012-2013Posted: 8/13/2012
- •
  Upcoming changes to the AIM Clinical GuidelinesPosted: 8/3/2012
- •
  Performing EGD and colonoscopy procedures on the same dayPosted: 7/31/2012
- •
  Retrospective chart review programPosted: 7/31/2012
- •
  Policy notifications posted as of July 25, 2012Posted: 7/31/2012
- •
  New initiative promotes the use of generic drugsPosted: 7/31/2012
- •
  Policy notifications posted as of June 22, 2012Posted: 6/29/2012
- •
  Choosing a safe, cost-effective setting for injectable and infusion therapy drugsPosted: 6/29/2012
- •
  The process of requesting retrospective reviews for inpatient staysPosted: 6/29/2012
- •
  Health care reform: Expansion of 100 percent coverage for women’s preventive health servicesPosted: 6/29/2012
- •
  Policy notifications posted as of May 21, 2012Posted: 5/31/2012
- •
  Changes to approved drug dose, frequency, or regimen must be resubmitted for precertificationPosted: 5/31/2012
- •
  Updated InterQual^® guidelines for 2012Posted: 5/31/2012
- •
  Policy notifications posted as of April 23, 2012Posted: 5/1/2012
- •
  Assessing the needs of high-risk Medicare Advantage HMO and PPO members Posted: 3/29/2012
- •
  Policy notifications posted as of March 26, 2012Posted: 3/29/2012
- •
  Low-dose chest CT screening for individuals at high risk for lung cancerPosted: 3/29/2012
- •
  Clarification on the use of Modifier 52Posted: 3/1/2012
- •
  Policy notifications posted as of February 21, 2012Posted: 3/1/2012
- •
  Policy notifications posted as of January 20, 2012Posted: 1/31/2012
Medi
2011 Updates
- •
  Policy notifications posted as of December 21, 2011Posted: 12/29/2011
- •
  Preferred providers for insulin pumps and continuous glucose monitoring related suppliesPosted: 12/29/2011
- •
  Reminder: Use of modifier-25 when reporting E&M services with spinal/extraspinal manipulation codesPosted: 12/29/2011
- •
  Reminder: New precertification requirements now in effect for Medicare Advantage HMO and PPO membersPosted: 12/29/2011
- •
  Reminder: Change to anesthesia claims payment methodology calculationPosted: 12/5/2011
- •
  Policy notifications posted as of November 23, 2011Posted: 12/1/2011
- •
  Prescription drug updatesPosted: 12/1/2011
- •
  Precertification process change for certain infusion therapy drugsPosted: 12/1/2011
- •
  Policy notifications posted as of October 27, 2011Posted: 11/1/2011
- •
  Specialists needed to assist in developing medical policiesPosted: 11/1/2011
- •
  Policy notifications posted as of September 23, 2011Posted: 10/3/2011
- •
  Policy reminder regarding utilization review decisions Posted: 10/3/2011
- •
  Policy on Modifier 52Posted: 10/3/2011
- •
  Precertification requirement changes for Medicare Advantage HMO and PPO membersPosted: 10/3/2011
- •
  Transitioning select infusion therapy drugs from the outpatient setting to the office or home settingPosted: 9/1/2011
- •
  New policy on inpatient hospital readmissionsPosted: 9/1/2011
- •
  Change in reimbursement for assistant-at-surgery servicesPosted: 9/1/2011
- •
  Policy notifications posted as of August 19, 2011Posted: 9/1/2011
- •
  Reminder: Use updated precertification requirements listsPosted: 9/1/2011
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 9/1/2011
- •
  Policy notifications posted as of July 20, 2011Posted: 7/28/2011
- •
  Updated procedures for requesting precertification for pain management, DME, and home health providersPosted: 7/28/2011
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 7/28/2011
- •
  Precertification requirement changes and updated lists available in JulyPosted: 7/1/2011
- •
  Policy notifications posted as of June 21, 2011Posted: 7/1/2011
- •
  Important information about the upcoming Clinical Care ReportPosted: 7/1/2011

Quick Links

Behavioral Health

Behavioral Health FAQ

Bulletins

Provider Data Maintenance

EFT Resources

Forms

Frequently Asked Questions

Manuals

Medical and Claim Payment Policy Portal

Opioid Awareness

Platform Transition

Provider eBusiness Inquiry form

Provider Home

Services that require precertification

Utilization Management

Value-based programs