Managed Care Policies & Procedures

"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.

Below are the changes to the managed care policies and procedures beginning August 1, 2019. To provide feedback, please complete this form.

Item Number Policy/Procedure Date Posted Public Comments Due By Status Document Links
2019-Chisholm-1 Chisholm Compliance MCO User Process Manual 10/29/19 12/13/19 Pending

Chisholm Compliance MCO User Process Manual

2019-Healthy Blue-95 MHR PSR Provider Bulletin 10/24/19 12/8/19 Pending

MHR PSR Provider Bulletin

2019-LHCC-54 PCP Selection Change 10/14/19 11/28/19 Pending

PCP Selection Change

2019-PHARM-2 MCO Criteria Changes 10/13/19 11/27/19 Pending MCO Criteria Changes
2019-LHCC-25 UM Communication Services 10/11/19 11/25/19 Pending UM Communication Services
2019-Healthy Blue-49 PA Req N Supervision for Hyperbaric O2 10/11/19 11/25/19 Pending PA Req N Supervision for Hyperbaric O2
2019-Healthy Blue-96 ICD-10 Coding Tips Sheet Flier 10/10/19 11/24/19 Pending ICD-10 Coding Tips Sheet Flier
2019-Healthy Blue-80 SBIRT Filter Update 10/10/19 11/24/19 Pending SBIRT Flier Update
2019 Healthy Blue-92 CCRT Configuration - PA Changes - Blue RFRF 10/10/19 11/24/19 Pending CCRT Configuration - PA Changes - Blue RFRF
2019-Healthy Blue-94 SUD Criteria for Prior Authorization 10/10/19 11/24/19 Pending SUD Criteria for Prior Authorization
2019-Healthy Blue-38 WAVE CG DME 46 Pneumatic 10/4/19 11/18/19 Pending WAVE CG DME 46 Pneumatic
2019-Healthy Blue-38 WAVE CG DME 46 Pneumatic 10/4/19 11/18/19 Pending WAVE CG DME 46 Pneumatic
2019-HPA-2 CLIA Number Information: Revised 11/15/19 12/30/19 Pending Revised HPA: CLIA Number Information

 

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