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effective-october-30-2020--clinical-policies
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Effective January 18 2021 Pharmacy and Biopharmacy Policies
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Effective September 23 2021 Pharmacy and Biopharmacy Policies
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Pharmacy and Biopharmacy Policies August
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September Clinical Policies
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November Clinical Policies
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Effective December Pharmacy and Biopharmacy Policies
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Ambetter Clinician-Administered Drug Prior Authorization Update
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Risk Adjustment Documentation and Coding
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Ambetter Plan Benefits Resume for Applicable COVID-19 Services
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November 2023 Pharmacy and Biopharmacy Policies
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Express Scripts Transition Frequently Asked Questions
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FAP Directory
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Effective January 31, 2024: Clinical Policies
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notice to physicians and providers 01042024
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Effective August 1, 2024: Clinical Policies
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Elimination of Certain Laboratory Services Payment Policies
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Clinical Payment Policies and Code Editing Payment Policy
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Ambetter Transitions to Availity Essentials
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Effective July 2025: New Payment Policy: Inpatient Claim Billing/Coding Reviews
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Effective July 1, 2025: Revised Payment Policy: Genetic and Molecular Testing Services
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Effective August 1, 2025: Genetic Testing PLA Expansion
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Cardiology Procedures: Transition of Utilization Review from TurningPoint to Evolent Effective for Service Dates beginning July 1, 2025
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Effective July 15, 2025: Pharmacy and Biopharmacy Policies
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Effective July 31, 2025: Clinical Policies
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Effective May 20, 2025: Clinical Policies
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Effective August 1, 2025: Pharmacy and Biopharmacy Policies
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Effective June 1, 2025: Pharmacy and Biopharmacy Policies
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NEW RESOURCE: Quality Rating System (QRS) Behavioral Health Measure Toolkit
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REMINDER: Ambetter Health Solutions Now Available
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Effective June 1, 2025: Ambetter Telehealth Update
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Effective October 1, 2025: New Prior Authorization Requirement for Certain Genetic and Molecular Testing
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Effective September 15, 2025: Clinical Policies
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Effective July 31, 2025: Clinical Policies
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Reminder: Claims Filing for Pre-Authorization Exemption Program
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Effective November 1, 2025: Pharmacy and Biopharmacy Policies
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Effective September 1, 2025: Pharmacy and Biopharmacy Policies
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Effective November 30, 2025: Clinical Policies
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Effective December 1, 2025: Pharmacy and Biopharmacy Policies
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Effective October 1, 2025: Pharmacy and Biopharmacy Policies
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New Payment Policy Effective January 1, 2026: Newborn Inpatient Stays
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Effective 1/1/26: Important Billing Code Update for Proprietary Laboratory Analysis
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Effective November 1, 2025: Pharmacy and Biopharmacy Policies
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Effective January 1, 2026: Pharmacy and Biopharmacy Policies
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Reminder: Check Three Items to Verify Member Eligibility
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Effective February 1, 2026: Pharmacy and Biopharmacy Policies
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Effective January 30, 2026: Clinical Policies
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Effective March 31, 2026: Clinical Policies
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Ambetter Health Billing Code Update for HCPC Codes G2211 & G2212: Effective 04/01/2026
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Upcoming Provider Satisfaction Survey
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Effective March 1, 2026: Pharmacy and Biopharmacy Policies
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Effective December 1, 2025: Pharmacy and Biopharmacy Policies
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Effective February 1, 2026: Pharmacy and Biopharmacy Policies
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Effective March 31, 2026: Clinical Policies
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Effective May 29, 2026: Clinical Policies
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New Payment Policy: Leveling of Care: Office-Based Evaluation and Management Over-coding
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Revised Implementation Date: New Payment Policy - Leveling of Care: Emergency Department Evaluation and Management Over-coding for Professional Services
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Now Available: Monogram Health Multispecialty Program
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Effective July 31, 2026: Clinical Policies
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Effective May 29, 2026: Clinical Policies
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Effective June 1, 2026: Pharmacy and Biopharmacy Policies
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Effective 06/30/26: Criteria Change for Cochlear Replacement and Repair Requests
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Effective 07/31/26: Criteria Change for Disc Decompression Procedures
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Effective 8/15/2026: Update for Procedure Codes S9083 and S9088
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