Reminders and Updates

Here’s when you can expect them for 2025.

Sending one appeal per patient helps us process your appeals faster.

More members will have no cost shares for supplemental or diagnostic breast examinations.

New rules are effective January 1, 2025, relating to the treatment of substance use disorders.

Additional information about new drug and biologic edits.

Learn about new Washington state requirements for cost-sharing, prior authorization, and reimbursement for HIV post-exposure prophylaxis drugs.

Payer name changes in Availity to include postal members.

Drug waste will be reimbursed when billed with correct modifiers.

Include a description of the service rendered when billing an unlisted procedure code.

When is it appropriate for your patient?

Help reduce your patients’ out-of-pocket costs.

Your office may receive a request for medical records.

Mark your calendar for benefit changes effective July 1.

Paper FEP explanation of payments ending August 1 for those using electronic funds transfer.

Make sure to append the correct modifier and number of units.

Durable medical equipment edits are coming to the claims editor.

Correct coding of diagnosis codes, procedure codes, and place of service codes to be implemented.

Comply with No Surprises Act requirements and verify your information with BetterDoctor.

Find the articles you need easier than ever.

Maximum daily units in claims editor explained.

Premera is expanding its formulary to include generic Fluticasone HFA.

New drug and biologic edits will be implemented to support medical and pharmacy policies.

Check out our new three-minute video and learn how to update your provider directory information.

Follow these simple steps to ensure you receive InstaMed autopayments in 2024.

90-day notice of changes for claims including an RA modifier.

Recent sensor failures are not detecting correct blood sugar levels.

Changes are in store for preventive benefits in 2024.

Upcoming 2024 claims editing projects.

Prior authorization requests must be re-submitted if attachments for more than one member are included.

Follow these steps to ensure you receive InstaMed autopayments in 2024.