October 2021

Neighborhood News

Announcements

• Improved Process for Requesting Multiple Claim Adjustments

Reminders

• Claim Submission Reminders for Providers and Billers
• Annual Provider Training Requirement
• Specialty Medication Prior Authorization Criteria
• Standard Coding Requirements Regarding Bundled Billing

Behavioral Health

• Annual Testing and Monitoring for Patients with Schizophrenia 
• Behavioral Health Identification, Treatment and Referral in Primary Care: 3-Part On-demand Series
• Behavioral Health News and Updates

Quality Improvement

• Updated Sexually Transmitted Infections Treatment Guidelines 2021
• Tobacco Cessation: Helping Members Quit
• National Lead Poisoning Prevention Week, October 25-31, 2021

Claims

• Claims Corner: Coordination of Benefits, Claim Reconsiderations, and Forms
• ABILITY – Electronic Claims Clearinghouse

Pharmacy

• Dispensing Pharmacy Notification for State-Supplied Vaccines
• Prescription Drug Coverage in Assisted Living and Long-term Care Facilities
• Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY (Medicare-Medicaid Plan) Members
• Medical Benefit and Medicaid Pharmacy Benefit Formulary Updates
• Medical Benefit Prior Authorization Submissions
• Medically Administered Infusions Available for Administration in the Home
• How to Bill 340B Appropriately
• Electronic Prior Authorization (ePA) for the Pharmacy Benefit
• Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications

The News and Updates section of the Neighborhood website is used to share important news and information, including notifications on payment policies, operational issues, and more.