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 Medical

The Medical section is designated for information pertaining to services covered under the medical benefit, including new and updated medical and claim payment policies, precertification changes, and utilization management programs.

Communications


Hide details for [<div class= 'YearCat'>&nbsp&nbsp2019 Updates</div><hr style='width:749px; color:#b6b6b6;background-color: #b6
  2019 Updates

Updated InterQual Criteria for 2019Posted: 07/15/2019
Specialty drugs that require precertification as of July 1, 2019Posted: 07/01/2019
The medical benefit specialty drug cost-sharing list updated as of July 1, 2019Posted: 07/01/2019
Clinical Appropriateness Guidelines for Advanced Imaging of the Heart updated as of July 1, 2019Posted: 07/01/2019
Clinical Appropriateness Guidelines for Arterial Ultrasound updated as of July 1, 2019Posted: 07/01/2019
Clinical Appropriateness Guidelines for Radiology updated as of July 1, 2019Posted: 07/01/2019
Radiation Therapy Clinical Guidelines updated as of July 1, 2019Posted: 07/01/2019
New Dosage and Frequency Program webpage now available Posted: 06/21/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 06/20/2019
Updated: New drugs added to the Dosage and Frequency Program Posted: 06/05/2019
Updates to the list of specialty drugs that will require precertification Posted: 06/03/2019
Tysabri added to the Most Cost-Effective Setting ProgramPosted: 05/30/2019
Preventive coverage of exercise interventions for the prevention of falls for commercial membersPosted: 05/22/2019
Measles disease outbreak and vaccine coverage for Independence commercial membersPosted: 05/20/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 05/20/2019
Cost-sharing and billing requirements for preventive colonoscopy and flexible sigmoidoscopyPosted: 05/06/2019
Preferred Skilled Nursing Facility Program now available for eligible Independence Medicare Advantage membersPosted: 05/01/2019
Updates to the medical benefit specialty drug cost-sharing listPosted: 05/01/2019
Clinical Appropriateness Guidelines for Advanced Imaging of the Heart to be updatedPosted: 05/01/2019
Clinical Appropriateness Guidelines for Arterial Ultrasound to be updatedPosted: 05/01/2019
Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 05/01/2019
Updated Radiation Therapy Clinical GuidelinesPosted: 04/22/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 04/22/2019
FDA releases statement on the efficacy of LartruvoPosted: 04/12/2019
Self-funded groups must elect to participate in vendor-based utilization management programsPosted: 04/08/2019
Mumps disease outbreak and vaccine coverage for Independence commercial membersPosted: 04/05/2019
Updates to Direct Ship Drug Program listPosted: 04/04/2019
Reminder: Updated reimbursement policies for CRNPs and PAs Posted: 04/03/2019
Claim reprocessing for multiple procedure payment reductions on certain diagnostic servicesPosted: 03/28/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 03/25/2019
Preventive coverage of spinal muscular atrophy screening Posted: 03/18/2019
Updated reimbursement policies for CRNPs and PAs Posted: 03/01/2019
View up-to-date policy activity on our Medical Policy PortalPosted: 02/22/2019
New drugs to be added to the Dosage and Frequency Program Posted: 02/18/2019
Updates to the list of specialty drugs that require precertification Posted: 02/15/2019
Four drugs added to Most Cost-Effective Setting Program Posted: 01/25/2019
Four drugs added to the Dosage and Frequency Program Posted: 01/25/2019
Reminder: Updated credentialing requirements for CRNPs and PAsPosted: 01/24/2019
New acupuncture benefit and network now in effectPosted: 01/22/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 01/22/2019
Changes coming to application of Modifier 59 in 2019Posted: 01/11/2019
Changes to the management of CAPS drugs now in effectPosted: 01/07/2019
Frequency limit established for trigger point injections for myofascial pain syndromePosted: 01/03/2019
Updated list of specialty drugs that require precertification now in effectPosted: 01/03/2019
Updated medical benefit specialty drug cost-sharing list now in effectPosted: 01/03/2019
Show details for [<div class= 'YearCat'>&nbsp&nbsp2018 Updates</div><hr style='width:749px; color:#b6b6b6;background-color: #b6
  2018 Updates

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  2017 Updates

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  2016 Updates

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  2015 Updates

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  2014 Updates

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  2013 Updates

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  2012 Updates

Show details for [<div class= 'YearCat'>&nbsp&nbsp2011 Updates</div><hr style='width:749px; color:#b6b6b6;background-color: #b6
  2011 Updates












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