Provider
QP1-25 Commercial Pharmacy Benefit Exclusion for Aucatzyl® and Rapiblyk™
Program effective Date: Jan 08, 2025
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Provider
QP3-25 Post-Payment Medical Necessity Review of Inpatient Admissions
Program effective Date: Jan 08, 2025
Provider
QP2-25 MHCP Pharmacy Benefit Exclusion for Aucatzyl®, Axtle™, Boruzu®, Rapiblyk™ and Ziihera®
Program effective Date: Jan 08, 2025
Benefits & Coverage
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How to Read Your Explanation of Health Care Benefits (EOB) Statement
Provider
P19R2-18 Update: New Remittance Code OA-45/N801 for Purchased/Referred Care (PRC) - Eligible Subscribers
Program effective Date: May 01, 2018
Provider
P26-17 New Drug-Related Prior Authorization (PA) Criteria: Urea Cycle Disorders
Program effective Date: May 25, 2017
Provider
P54-16 Added Reimbursement Policies
Program effective Date: Nov 14, 2016
Provider
P18-17 New Drug-Related Prior Authorization Requirements for Nusinersen (Spinraza)
Program effective Date: May 02, 2017
Provider
P59-18 New Acupuncture Update for Commercial Lines of Business - Effective January 1, 2019
Program effective Date: Nov 01, 2018
Provider
P59-17 Government Programs Subscribers Prior Authorization Requirement for Spinal Fusion: Lumbar
Program effective Date: Nov 01, 2017