Provider guidance for reimbursement, enrollment and providing care for Medicaid beneficiaries
Topics Related to Division of Health Benefits
Information on key benefits, copay exceptions and rates effective Oct. 1, 2024.
To support providers with the launch of Tailored Plans, certain Transition of Care policy flexibilities have been extended.
Providers are encouraged to contact health plans to address any discrepancies in claim payment issues prior to escalating to the Provider Ombudsman
Provider Taxonomy codes required when submitting claims to Tailored Plans.
Guidance for providers directly billing Medicare for services provided to patients with retroactive Medicare enrollment dates
An amended version of Clinical Coverage Policy 5B, Orthotics and Prosthetics promulgated on July 15, 2024.
The 2025 ICD-10 update is effective Oct. 1, 2024, through Sept. 30, 2025, for provider use for dates of service within this period.
Guidance based on products approved by the FDA and recommended by the CDC Advisory Committee on Immunization Practices (ACIP).
Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.