News and Updates

December 20, 2024

275 claim attachment transactions update (PDF)

December 12, 2024

Participating provider office standards for access and availability (PDF)

December 3, 2024

Use the correct payer ID when filing claims (December Reminder) (PDF)

November 26, 2024

Formulary update (January 1, 2025) (PDF)

November 21, 2024

Restoration of Optum/Change Healthcare connectivity (PDF)

October 28, 2024

Introduction to Optum’s “Prospective Inpatient Claim Review” and “Credit Balance Review” programs (PDF)

October 25, 2024

Provider Manual revisions (January 2025) (PDF)

October 24, 2024

Provider information security awareness (PDF)

October 24, 2024

Reminder: Use of modifiers for physical, occupational, and speech therapy and physical rehabilitation (PDF)

October 15, 2024

CPT CAT II code incentive program (PDF)

October 11, 2024

Provider satisfaction survey reminder (PDF)

October 7, 2024

Attestation requirement: Provider Data Information Form (PDF)

October 4, 2024

PerformPlus® Gaps in Care Closure Program (PDF)

October 2, 2024

Pfizer voluntarily withdraws all lots of sickle cell disease treatment Oxbryta® (voxelotor) from worldwide markets (PDF)

September 16, 2024

Kidney and eye health evaluation for patients with diabetes (PDF)

September 11, 2024

Population Health program/coordination of medical care (PDF)

September 9, 2024

275 claim attachment transaction is now available via Availity (PDF)

September 6, 2024

Reminder to use the Provider Appeal Form available on our website (PDF)

September 5, 2024

Formulary update (November 1, 2024) (PDF)

September 3, 2024

Reminder to use the correct payer ID when filing claims (PDF)

August 22, 2024

Lab test billing reminder (PDF)

August 16, 2024

Provider manual revisions (August 2024) (PDF)

August 13, 2024

Balance or surprise billing reminders for Florida Next members (PDF)

July 29, 2024

Exchange Risk Adjustment Overview and Documentation Guidance (PDF)

July 26, 2024

Change Healthcare ConnectCenter™ Update (PDF)

July 15, 2024

Prior Authorization Requirement Changes (PDF)

July 3, 2024

Formulary update (August 1, 2024) (PDF)

July 1, 2024

Provider Data Information Form (PDF)

June 12, 2024

Reminder to Use the Correct Payer ID When Filing Claims (PDF)

June 7, 2024

Reminder to Direct Members to AmeriHealth Caritas Next Participating Labs (PDF)

May 31, 2024

No-Cost Smoking Cessation Therapy (PDF)

May 16, 2024

Remittance Advice Payment Recovery Details Now Available! (PDF)

May 3, 2024

Change Healthcare Restoration of Services Status (PDF)

April 19, 2024

Breast Cancer Screening of Women With Schizophrenia — An Opportunity for Improvement (PDF)

April 15, 2024

National Imaging Associates is becoming Evolent (PDF)

April 12, 2024

Provider Data Information Form (PDF)

April 9, 2024

Prior Authorization Guidelines Tip Sheet: ADHD Medications (PDF)

April 5, 2024

Formulary update (May 1, 2024) (PDF)

March 25, 2024

Claims Timely Filing Deadline Extension (PDF)

March 25, 2024

Electronic Remittance Advice (ERA/835) Access (PDF)

March 21, 2024

Availity Additional Information Provider Notice (PDF)

March 8, 2024

Claim Submission Options Update (PDF)

March 6, 2024

Changes to Coverage of Diabetes Equipment and Supplies (PDF)

March 6, 2024

Alternative Claim Submission Option Available (PDF)

February 12, 2024

Healthcare Effectiveness Data and Information Set (HEDIS®) (PDF)

January 3, 2024

Use the correct plan payer ID when filing claims (PDF)

December 6, 2023

Formulary update (January 1, 2024) (PDF)

November 30, 2023

Prior authorization requirement changes for select procedure/HCPCS codes (PDF)

November 28, 2023

Lab test billing reminder (PDF)

November 3, 2023

Provider satisfaction survey reminder (PDF)

November 3, 2023

PerformPlus® Gaps in Care Closure program (PDF)

October 12, 2023

Prior authorization request reminder (PDF)

October 9, 2023

Use of AT modifier for chiropractic care (PDF)

September 26, 2023

Formulary update (September and October 2023) (PDF)

August 17, 2023

Formulary update (September 5, 2023) (PDF)

August 4, 2023

Submission of electronic documentation (275 Transactions) (PDF)

August 1, 2023

Updated practitioner credentialing rights (PDF)

July 26, 2023

Use of modifiers for physical, occupational, and speech therapy, and physical rehab (PDF)

July 26, 2023

Use of modifiers for chiropractic care (PDF)

July 25, 2023

Care Gaps that can be closed in NaviNet (PDF)

July 18, 2023

Provider Data Information Form (PDIF) attestation instructions (PDF)

July 17, 2023

Formulary update (August 1, 2023) (PDF)

June 26, 2023

EDI compliance upgrade to SNIP Level 4 effective July 20, 2023 (PDF)

May 9, 2023

Akorn issues voluntary nationwide recall of various human and animal drug products within expiry due to company shutdown (PDF)

April 20, 2023

FDA Commissioner and Chief Scientist announce decision to withdraw approval of Makena (PDF)

April 15, 2023

Pharmacy formulary update (May 15, 2023) (PDF)