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October 2014 Edition Articles


Changes coming to out-of-pocket maximums for commercial HMO, POS, and PPO members P, F, A
Changes to the QPM score program for measurement year 2014 P
Encourage members to exercise to help reduce their risk of falling P
Highlighting HEDIS®: Use of imaging studies for low back pain P
Important news about the annual Synagis® (palivizumab) distribution program P
Medical and claim payment policy activity posted from August 23 – September 25, 2014 P, F, A
Medicare supplemental claim rejections F
More changes coming in October to NaviNet® P, F, A
New Care Cost Estimator tool available for migrated PPO and PHO members P
New coverage criteria for repository corticotropin (H.P. Acthar® Gel Injection) P
New Medicare Advantage HMO and PPO policy notifications now available
P, F, A
New precertification requirements for DME providers A
Quality ranking for primary care offices P
Recent changes to our ePASS® incentive opportunity for professional providers P
Reminder: Receiving infliximab (Remicade®) in cost-effective settings P
Upcoming change to Multiple Procedure Payment Reduction guidelines for certain diagnostic services P
Upcoming changes to medical policies on spinal injections P, F, A
Upcoming changes to our precertification process for outpatient echocardiography services for Medicare Advantage HMO and PPO members P, F
Upcoming changes to precertification requirements for outpatient radiation therapy P, F
Upcoming changes to precertification requirements P
Upcoming Medicare Advantage HMO and PPO benefits changes P, F, A
Update on our Business Transformation P, F, A




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