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Provider News

  • Prenatal Service Third-party Liability Change

    September 19, 2019 – The Bipartisan Budget Act of 2018 made changes to the coordination of benefits process for prenatal services, which formerly received special treatment under the Medicaid third-party liability requirements. The act directs Medicaid to apply the standard coordination of benefits rule when processing...

  • June 2019 Medical Policies and Clinical Utilization Management Guidelines Update

    September 5, 2019 – The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not...

  • Clinical Criteria Web Posting July 2019

    September 4, 2019 – On June 20, 2019, the Pharmacy and Therapeutic (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Healthy Blue. These policies were developed, revised or reviewed to support clinical coding edits.

  • Information About Hurricane Dorian for Healthy Blue Providers

    September 4, 2019 – Healthy Blue is here to work with you to ensure our members will continue receiving the same quality of care during this time. We are committed to assisting our providers and members in resolving any issues related to Hurricane Dorian.

  • BabyNet Services for Healthy Connections Members

    September 1, 2019 – Effective October 1, 2019, Healthy Blue will assume educational review and payment responsibility for BabyNet services for Healthy Connections members. According to South Carolina Department of Health and Human Services (SCDHHS), BabyNet is the state’s early intervention system for infants and...

  • BlueBlast – September 2019

    August 30, 2019 – September 2019 issue of BlueBlast. Every year at this time, we offer update/educational meetings for our providers. These meetings are intended to be helpful to you, as we share information on changes in our provider networks; South Carolina Department of Health and Human Services updates; quality...

  • Prior Auth Changes CCRT Configuration

    August 29, 2019 – Effective November 1, 2019, prior authorization (PA) requirements will change for the following services. These services will require PA by Healthy Blue for Medicaid members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including...

  • Pharmacy Benefit Manager Change to IngenioRx

    August 19, 2019 – Effective October 1, 2019, IngenioRx will become the pharmacy benefit manager (PBM) for prescription drugs, home-delivery pharmacy and specialty pharmacy for Healthy Blue members. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of BlueChoice...

  • MCG Care Guidelines Update and Customizations

    August 12, 2019 – Effective November 1, 2019, customizations will be implemented for Chemotherapy and Inpatient & Surgical Care (W0162) for adult patients.