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FLASH: CMS Guidelines and Inpatient Admissions

The 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) from the Centers for Medicare & Medicaid Services (CMS), effective January 1, 2024, outlined important information around Medicare Advantage enrollee admission for inpatient care.

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December 2023 Newsletter

Wishing You a Happy and Healthy Holidays It’s hard to believe it’s already the holiday season, with another new year right around the corner. We’re grateful for all you’ve done for our members – and for us – throughout 2023, and we can never thank you enough for your partnership. We hope you, your staff and all your loved ones have a beautiful, cheerful and blessed holidays. As together we embark upon 2024, we’re forever thankful that you’re our partner.

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Flash – CGM Changes – Changes for Continuous Glucose Monitors

Beginning on January 1, 2024, Health AllianceTM will require durable medical equipment suppliers to bill for non-adjunctive Continuous Glucose Monitors (CGM) via pharmacy benefits through Optum for all Commercial plans.  In addition, our Medicare plans will allow for those members to receive their CGM’s either through a retail pharmacy or through a durable medical equipment supplier.  Those devices are typically billed with E2103 for the receiver and A4239 for the related supplies.

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FLASH: Skin Substitutes – Prior-Authorization Changes

Health Alliance is dedicated to constantly improving its services. Therefore, our Medical Directors and coding experts conduct an annual review of all medical policies to ensure compliance with industry and clinical best practices.

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FLASH: Health Alliance Prior Authorization Changes for 2024

Each year, Health AllianceTM performs a comprehensive review and analysis around services needing prior authorization. In our last review cycle, we removed prior authorization around ultrasound, oxygen therapy, non-urgent ground ambulance and select DME items.

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