Updates & Announcements

We strive to make partnering with us simple. We’re aware things may change in the way we do business with you and want to communicate these changes to you in an efficient manner.

  • Pharmacy information, including our Preferred Drug Lists (PDLs)
  • Medical, pharmacy, reimbursement and administrative policies
  • Authorization requirements as communicated through network notifications below 

The links below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.

2020Date
NavigatePolicy Updates April 202004/01/2020
NavigateJanuary/February Provider Portal Updates03/30/2020
NavigateCOVID-19: Temporary Telehealth Services03/27/2020
NavigateFQHC and RHC Provider Billing Reminder03/27/2020
NavigateProtecting Members and Reducing the Spread of COVID-1903/13/2020
NavigateIssue Resolution: Electronic Remittance Advice (ERA) PLB and Claim Level Adjustments03/13/2020
NavigateProvider Portal Quick Start Guide03/11/2020
NavigateConsent Forms Reminder03/05/2020
NavigateFQHC Use of Uniform Billing Form UB-04 – UPDATE03/03/2020
NavigateAccess and Availability Standards03/02/2020
NavigatePolicy Updates March 202003/01/2020
NavigateFQHC Use of Uniform Billing Form UB-04 – This notification has been revised. See notification dated 03/03/2020.02/19/2020
NavigateAnnual Notice of Requirements02/19/2020
NavigatePatient-Driven Groupings Model Implementation02/19/2020
NavigateInstructions on Attaching Medical Records in Provider Portal02/07/2020
NavigatePolicy Updates February 202002/01/2020
NavigateOpioid Treatment Program Reimbursement01/28/2020
NavigateRecent Provider Portal Updates01/28/2020
NavigatePaper Checks Dated 1/21, 1/22, 1/2301/27/2020
NavigateInpatient Facility Claims Guidelines01/20/2020
NavigatePolicy Updates January 2020 – UPDATE01/20/2020
NavigateProvider Payment Migration Complete01/13/2020
NavigateHigh Dollar Claims Cover Sheet – UPDATE01/07/2020
Policy Updates January 2020 – This notification has been revised. See notification dated 01/20/2020.01/01/2020
2019Date
NavigateRegister with New Payment Partner ECHO Health by December 13 – Deadline Extended Again!12/02/2019
NavigatePolicy Updates December 201912/01/2019
NavigateHoliday Claim Remittance Delay11/26/2019
NavigateICD-10 Code Update11/26/2019
NavigateFlu Vaccine Initiative11/13/2019
NavigatePolicy Updates November 201911/01/2019
NavigateDual-Eligibility Billing Reminder10/31/2019
NavigateOut of Network Hospice Providers Reminder10/23/2019
NavigatePolicy Updates October 201910/01/2019
NavigateRegister with New Payment Partner ECHO Health by December 1 – This notification has been revised. See notification dated 12/02/201909/25/2019
NavigateRecent Provider Portal Updates – UPDATED 10/309/23/2019
NavigateNotice of CareSource Advantage Plus Plan Cancellation09/17/2019
NavigatePatient-Driven Payment Model Reminder09/13/2019
NavigateConsent Form Upload Enhancement to the Provider Portal – UPDATE09/05/2019
NavigateEnhancements to Prior Authorization on Provider Portal09/05/2019
NavigateSeptember 2019 Policy Updates09/01/2019
NavigateIssue with Denials for Physical Therapy (PT) Units08/23/2019
NavigateIssues with Outpatient Claim Denials Due to Authorizations Expiring08/23/2019
Navigate2019-2020 Ohio Provider Manual Now Available08/06/2019
NavigatePolicy Updates August 201908/01/2019
NavigateRegister with New Payment Partner ECHO Health by October 25 – This notification has been revised. See notification dated 09/25/201907/26/2019
NavigateDuplicate Modifier on the Claim Service Line07/17/2019
NavigatePost-Payment Audit Update07/12/2019
NavigateProvider Dispute Process07/05/2019
NavigatePolicy Updates July 201907/01/2019
NavigateMulti-Factor Authentication Scheduled for SKYGEN CWP06/21/2019
NavigatePrior Authorization Enhancements for Observation Stays06/13/2019
NavigateInpatient Hospital Pre-payment Claims Reviews - Revised 6/6/201906/03/2019
NavigatePolicy Updates June 201905/31/2019
NavigateTips to Improve Pediatric CAHPS Ratings05/29/2019
NavigateEnd-Stage Renal Disease (ESRD) Claims and Value Code D505/29/2019
NavigateDesignating a Supervising Provider Using Paper Claims05/17/2109
NavigateUpgrades to AHS Consent Form on the Provider Portal05/13/2019
NavigateClaim Appeals Initial Determination for Payment05/06/2019
NavigateAccess Standards Update05/06/2019
NavigatePolicy Updates May 201905/01/2019
NavigatePolicy Updates April 201904/01/2019
NavigateEnhancements to Delivery and Newborn Notifications – UPDATE03/28/2019
NavigateProvider Portal Survey03/07/2019
NavigatePolicy Updates May 201903/01/2019
NavigateHigh Dollar Claims – This notification has been revised. See notification dated 01/07/202002/19/2019
NavigateBehavioral Health Claim Issue Identified - UPDATE02/19/2019
NavigatePlace of Service Code for Claim Submissions02/14/2019
NavigateRevenue Code 0636 Denials Update02/13/2019
NavigateNational Drug Code (NDC) with J1050 Denials Update02/08/2019
NavigateEnhancements to Delivery and Newborn Notifications02/01/2019
NavigateHepatitis A Prevention01/29/2019
NavigatePolicy Updates March 201901/24/2019
NavigateDiagnosis Related Group (DRG) Validation Audits01/21/2019
NavigateIssues with Mammogram Benefit Limits01/14/2019

This information is not a complete description of benefits. Call 1-844-607-2827 (TTY: 1-800-750-0750 or 711) for more information.