Newsletters and Updates
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Provider alerts
- January 7, 2025
275 claim attachment transactions update (PDF) - January 2, 2025
Submitting explanation of benefits (EOB) from other insurance coverage (PDF) - December 19, 2024
Happy holidays! (PDF)
Previous provider alerts
2025
2024
- December 2, 2024
Provider Advisory Council Meeting (PDF) - November 25, 2024
Second alert: Restoration of Optum/Change Healthcare connectivity (PDF) - November 20, 2024
Cost-free language, conversion, and auxiliary aid services (PDF) - November 18, 2024
Restoration of Optum/Change Healthcare connectivity (PDF) - November 13, 2024
Prior authorization changes for select CPT/HCPCS codes (PDF) - November 8, 2024
Provider Advisory Council meeting is on December 5, 2024 (PDF) - November 7, 2024
Children’s National vaccination event (PDF) - November 6, 2024
Pharmacy electronic prior authorization changes (PDF) - November 6, 2024
Dental communications resources list (PDF) - October 18, 2024
National Prescription Drug Take Back Day (PDF) - October 14, 2024
Remind patients to get vaccinated this fall and winter (PDF) - October 14, 2024
Prior authorization changes for select CPT/HCPCS codes (PDF) - October 11, 2024
Fall provider newsletter available online (PDF) - October 3, 2024
Dental provider satisfaction survey — drawing for $100 gift card (PDF) - September 26, 2024
Dental provider satisfaction survey — one day left reminder (PDF) - September 16, 2024
Dental provider satisfaction survey (PDF) - September 16, 2024
Periodontal services referrals to Howard University College of Dentistry (PDF) - September 6, 2024
Provider Advisory Committee meeting (PDF) - September 5, 2024
Enhanced Reimbursement for Primary Care Services program FAQ (PDF) - September 3, 2024
Dental provider satisfaction survey (PDF) - September 3, 2024
275 claim attachment transaction is now available via Availity (PDF) - August 19, 2024
Dental provider satisfaction survey (PDF) - August 12, 2024
Prior authorization changes for select CPT/HCPCS codes (PDF) - July 30, 2024
Change Healthcare ConnectCenter update (PDF) - July 11, 2024
Updated claims requirement — CDT code D7473 mandibular torus removal (PDF) - July 8, 2024
Updated prior authorization requirements (PDF) - June 10, 2024
Introduction to Optum, LLC’s prospective review process (PDF) - June 4, 2024
Value-based care learning collaborative: Improve quality, outcomes, and value in health care (PDF) - May 31, 2024
Spring provider newsletter available online (PDF) - May 21, 2024
Optum pre-payment deny edit for anatomical modifiers (PDF) - May 20, 2024
New dose rounding policy exception criteria (PDF) - May 14, 2024
Remittance advice payment recovery details now available! (PDF) - May 9, 2024
Submitting adjustments for previously paid claims (PDF) - April 30, 2024
Change Healthcare restoration of services (PDF) - April 15, 2024
Reimbursement policies (PDF) - April 3, 2024
Encourage patients to complete the patient experience survey (PDF) - April 2, 2024
Claims timely filing deadline extension (PDF) - April 2, 2024
National Imaging Associates becoming Evolent (PDF) - April 2, 2024
Electronic remittance advice (ERA/835) access (PDF) - March 27, 2024
Duplicate checks dated February 29, 2024 (PDF) - March 20, 2024
Post-appointment survey provider scorecard available in NaviNet (PDF) - March 20, 2024
Additional information on electronic claims submission to Availity (PDF) - March 18, 2024
Clinical practice guidelines (PDF) - March 15, 2024
Implementation of Optum outpatient edits (PDF) - March 12, 2024
New ADA guideline recommends NSAIDs to manage dental pain in adults (PDF) - March 8, 2024
Claim submission options update (PDF) - March 7, 2024
Alternative claim submission option available (PDF) - March 5, 2024
Scheduled RadMD outage (PDF) - March 4, 2024
Change Healthcare system interruption - Update (PDF) - February 26, 2024
Change Healthcare system interruption (PDF) - February 23, 2024
Disconnection of Change Healthcare system (PDF) - February 20, 2024
Reduction/removal of prior authorization requirement for select services and procedures (PDF) - February 2, 2024
Screening for substance use disorder in pediatric care survey (PDF) - January 29, 2024
Duplicate therapy notification (PDF) - January 26, 2024
Leadership through change learning collaborative (PDF) - January 23, 2024
HEDIS notification (PDF) - January 11, 2024
Provider manual updates (PDF) - January 10, 2024
Winter provider newsletter available (PDF) - January 8, 2024
AmeriHealth Caritas DC to manage prior authorization requests currently managed through eviCore healthcare beginning January 12, 2024 (PDF) - January 3, 2024
Value-based contract measurement year commencement (PDF)
2023
- December 20, 2023
Enrollee rights and responsibilities (PDF) - December 20, 2023
Accessing assigned enrollees list from SKYGEN provider web portal (PDF) - December 19, 2023
Happy holidays! (PDF) - December 15, 2023
Updates to value-based compensation program for providers who furnish health services to AmeriHealth Caritas DC enrollees (PDF) -
December 11, 2023
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November 30, 2023
- November 22, 2023
Provider manual updates (PDF) -
November 17, 2023
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November 9, 2023
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November 6, 2023
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November 3, 2023
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November 2, 2023
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November 1, 2023
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October 31, 2023
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October 10, 2023
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October 3, 2023
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October 2, 2023
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October 2, 2023
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September 26, 2023
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September 25, 2023
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September 19, 2023
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September 15, 2023
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September 13, 2023
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September 13, 2023
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September 7, 2023
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September 1, 2023
- August 31, 2023
Distribution of 2023 – 2024 flu vaccines (PDF) - August 29, 2023
Provider manual updates (PDF) - August 29, 2023
Medicaid Business Transformation DC webinars (revised 8/25/23) (PDF) - August 2, 2023
D8680 orthodontic retention submission practices (PDF) - July 28, 2023
Medicaid Business Transformation DC webinars (PDF) - July 13, 2023
D2950 core buildup (PDF) - June 30, 2023
Dental provider supplement updates (PDF) - June 14, 2023
eviCore provider orientation session schedule update (PDF) - June 8, 2023
New partnership with UpLift (PDF) - June 7, 2023
2023 provider satisfaction survey (PDF) - May 31, 2023
New NaviNet provider tools (PDF) - May 23, 2023
eviCore provider orientation session schedule (PDF) - May 22, 2023
2019 ADA claim form (PDF) - May 19, 2023
SNIP level 4 claims upgrade (PDF) - May 17, 2023
Akorn recall (PDF) - May 17, 2023
Provider manual update (PDF) - May 16, 2023
Upcoming provider advisory committee meeting (PDF) - May 15, 2023
New collaboration with eviCore healthcare (PDF) - April 25, 2023
Provider advisory committee meeting (PDF) - April 20, 2023
Orthodontic benefit terminates at age 21 (PDF) - April 12, 2023
Enrollee nebulizer reminder (PDF) - April 3, 2023
March of Dimes e-learning provider training reminder (PDF) - March 1, 2023
Consumer Assessment of Healthcare Providers and Systems (CAHPS) annual survey (PDF) - February 23, 2023
Updated training material for NaviNet medical authorizations is now available online (PDF) - February 20, 2023
New coverage for caries risk assessments (PDF) - February 3, 2023
Dental provider manual updates (PDF) - January 13, 2023
Periodontal services referrals to Howard University College of Dentistry (PDF) - January 9, 2023
New solution for online prior authorizations (PDF) - January 3, 2023
Updated process to access the Obstetric Needs Assessment Form (ONAF) (PDF)
2022
- December 20, 2022
Value-based compensation program (PDF) - December 15, 2022
Clinical practice guideline updates (PDF) - December 8, 2022
New provider newsletter available online (PDF) - December 6, 2022
MOD - How to Access Your eLearning Module (PDF) - November 30, 2022
Cooking with Gas: Health Harms from Gas Stove (PDF) - November 8, 2022
Oral Care Connect Introduction Letter (PDF) - November 3, 2022
CME/CNE Provider Training (PDF) - October 28, 2022
VBP Webinar Series (PDF) - October 20, 2022
Balloon Ostial Dilation (PDF) - September 29, 2022
New 3M™ health information systems dashboard (PDF) - September 26, 2022
Monitored anesthesia care for gastrointestinal endoscopy (PDF) - September 23, 2022
March of Dimes Breaking Through Bias in Maternity Care Provider Training on October 12, 2022 (updated 9/23/22) (PDF) - September 15, 2022
DC Mental Health Access in Pediatrics (DC MAP) (PDF) - August 29, 2022
Jiva Training Webinar (PDF) - August 24, 2022
Recovery Month Documentary (PDF) - August 23, 2022
March of Dimes Breaking Through Bias in Maternity Care Provider Training on October 12, 2022 (PDF) - August 10, 2022
Medicaid Enrollment Process (PDF) - August 4, 2022
Prenatal Telehealth Visits (PDF) - August 2, 2022
Redetermination Reminder (PDF) - August 1, 2022
March of Dimes Breaking Through Bias in Maternity Care Provider Training (PDF) - July 27, 2022
Provider Advisory Committee Meeting (PDF) - July 27, 2022
Resolution for Claims Processing Error (PDF) - July 22, 2022
Collecting Social Determinant of Health Data (PDF) - July 20, 2022
Small Business Development Program (PDF) - July 19, 2022
Consent Webinar Series (PDF) - July 8, 2022
March of Dimes Provider Notice (PDF) - July 6, 2022
New Provider Newsletter (PDF) - June 30, 2022
Provider Summary of Authorization Status (PDF) - June 14, 2022
CAQH ProView Information (PDF) - May 16, 2022
Continuation of care submission form update (PDF) - May 13, 2022
DC mental health access in pediatrics (DC Map) (PDF) - May 10, 2022
Upcoming Jiva training webinars (PDF) - April 27, 2022
Site visits and contact information updates (PDF) - April 15, 2022
New Handicapping Labio-lingual Deviation (HLD) score sheet (PDF) - April 5, 2022
Integrated Care DC Newsletter (PDF) - March 25, 2022
Enrollee balance billing (PDF) - March 23, 2022
Refund check requests (PDF) - March 23, 2022
SKYGEN provider web portal (PDF) - March 18, 2022
Modifier 25 policy termination (PDF) - March 17, 2022
Addition of Bicillin L-A to formulary (PDF) - March 17, 2022
Quality enhancement program update (PDF) - March 17, 2022
Discontinuation of Basaglar exception (PDF) - March 11, 2022
NaviNet upgrades for Condition Optimization program (PDF) - March 11, 2022
Provider manual update (PDF) - March 7, 2022
COVID-19 vaccine provider enrollment (PDF) - March 7, 2022
Updating your demographic information (PDF) - February 23, 2022
Formulary update: Aimovig® product removal (PDF) - February 23, 2022
Grubb's pharmacy participation update (PDF) - February 10, 2022
Vaccine ordering — new guidance from CDC (PDF) - February 3, 2022
Phillips respironics medical device recall (PDF) - February 1, 2022
Supply chain alert: long acting insulin coverage (PDF) - January 20, 2022
Avesis polycarbonate lens update (PDF) - January 20, 2022
Deposit days update (PDF) - January 14, 2022
HEDIS medical record review (PDF) - January 12, 2022
DC Mental Health Access in Pediatrics (DC MAP) (PDF) - January 5, 2022
New reporting requirements (PDF) - January 5, 2022
Balance billing (PDF)
2021
- December 16, 2021
VBP update (PDF) - December 14, 2021
Changes to the dental value-based compensation program for 2022 (PDF) - December 3, 2021
Long-acting insulin coverage (PDF) - December 1, 2021
Upcoming JIVA training sessions (PDF) - November 22, 2021
New provider newsletter available online (PDF) - November 5, 2021
A collaborative approach for safe use of opioids developed by DHCF & the District's DUR Board in collaboration with stakeholders (PDF) - November 3, 2021
Surescripts electronic prior authorization provider communication (PDF) - October 28, 2021
Prior authorization submission tip sheet (PDF) - October 27, 2021
Lead screening provider fax (PDF) - October 27, 2021
Flu shot reminder (PDF) - October 25, 2021
Condition Optimization Prospective Outreach Program training dates (PDF) - October 19, 2021
Grubb's pharmacy locations update (PDF) - October 8, 2021
Long-term care electronic prescription order forms (PDF) - October 8, 2021
Billing for antibody infusions (PDF) - October 7, 2021
Fiscal year 2022 Medicaid hospice rates (PDF) - October 7, 2021
Integrated care technical assistance program information session (PDF) - October 1, 2021
Introducing the CARE Card Rewards Program for enrollees (PDF) - September 13, 2021
Attending provider enrollment and NPI requirements for institutional claims (PDF) - September 10, 2021
Endovascular treatment for intermittent claudication policy (PDF) - September 10, 2021
Wheelchair mobility assistive device reimbursement policy (PDF) - September 10, 2021
Seasonal influenza testing policy (PDF) - September 10, 2021
In-office laboratory testing (PDF) - September 10, 2021
Presumptive and definitive drug testing payment policy (PDF) - September 9, 2021
Reimbursment rate changes for physical therapy (PT), occupational therapy (OT), speech and language therapy (ST) (PDF) - September 2, 2021
Grubb's NW Specialty Pharmacy no longer participating with AmeriHealth Caritas District of Columbia (PDF) - September 1, 2021
Introducing the condition optimization prospective outreach program (PDF) - August 30, 2021
Formulary change — Colonoscopy prep products (PDF) - August 5, 2021
D3110 fee schedule update (PDF) - August 3, 2021
AmeriHealth Caritas District of Columbia providers can now run NaviNet reports at the Tax ID Number (TIN) level (PDF) - August 2, 2021
Coming soon! New program encourages PCPs to proactively schedule routine office visits (PDF) - August 2, 2021
MYidealDoctor is becoming RelyMD (PDF) - July 26, 2021
Introducing emotional support via text (PDF) - July 20, 2021
DC Safe Sleep Survey (PDF) - July 9, 2021
Small business development program (PDF) - July 9, 2021
Procedure codes that do not require pre-authorization (PDF) - June 23, 2021
Verification process for provider demographic information (PDF) - June 22, 2021
Monthly Jiva training sessions offered at no cost via webinar (PDF) - June 2, 2021
New provider newsletter edition available online (PDF) - June 1, 2021
COMPASS℠ program primary care providers (PDF) - June 1, 2021
COMPASS℠ program specialists (PDF) - May 20, 2021
Lowest cost site of care medical pharmacy policy (PDF) - May 20, 2021
District of Columbia promoting interoperability program (PDF) - May 19, 2021
Standards for accessing primary and specialty care (PDF) - May 18, 2021
Clinical practice guidelines updates (PDF) - May 14, 2021
Use of the KX modifier for transgender patients (PDF) - May 14, 2021
Pharmacy prior authorizations (PDF) - May 3, 2021
Network outreach for dental providers (PDF) - April 29, 2021
Buprenorphine prescribing updates for opioid use disorder (PDF) - April 16, 2021
2021 CAHPS® survey (PDF) - April 15, 2021
Prior authorization requirement for chiropractic services (PDF) - April 2, 2021
Update to Optum claims review (PDF) - April 1, 2021
2021 child and adolescent immunization schedule (PDF) - March 19, 2021
Inpatient-only claim edits for certain surgical procedures (PDF) - March 18, 2021
Prior authorization update (PDF) - March 15, 2021
Prescription drug monitoring program requirements (PDF) - March 4, 2021
COVID-19 vaccine updates from DC Health (PDF) - March 1, 2021
Reminder: upcoming implementation of the electronic visit verification system (PDF) - March 1, 2021
Reminder: opioid medication prescribing limits (PDF) - February 23, 2021
Modifier 25 policy update (PDF) - February 15, 2021
Medical record review by OptumInsight Inc. (PDF) - February 10, 2021
Provider manual updates (PDF) - February 4, 2021
Orthodontic services for enrollees ages 0 – 20 Opens a new window (PDF) - January 22, 2021
The importance of race, ethnicity, and language data Opens a new window (PDF) - January 22, 2021
Culturally and linguistically appropriate services (CLAS) and patient health Opens a new window (PDF) - January 19, 2021
D7950 code clarification of the dental fee schedule Opens a new window (PDF) - January 14, 2021
Formulary update Opens a new window (PDF) - January 12, 2021
Medicaid enrollment process Opens a new window (PDF) - January 11, 2021
Vaccine ordering timeline and updates (PDF) - January 6, 2021
No-cost continuing medical education (CME) opportunity on the topic of sexual orientation and gender identity SOGI (PDF)
2020
- December 18, 2020
SKYGEN USA will be partnering with Zelis payments to enhance the electronic payment process Opens a new window (PDF) - December 15, 2020
2020 – 2021 HEDIS® Documentation and Coding Guidelines available online Opens a new window (PDF) - December 4, 2020
Integrated care technical assistance program Opens a new window (PDF) - December 3, 2020
Continuous glucose monitoring products added to formulary Opens a new window (PDF) - December 3, 2020
Vaccines for Children Program (expedited vaccine ordering timeline for December) Opens a new window (PDF) - November 20, 2020
Formulary removal changes Opens a new window (PDF) - November 19, 2020
RPM flyer and referral form Opens a new window (PDF) - November 19, 2020
DHCF provider town hall forum invite Opens a new window (PDF) - November 18, 2020
Reminder: Upcoming implementation of the electronic visit verification system Opens a new window (PDF) - November 13, 2020
HEDIS® tips for well-child visits Opens a new window (PDF) - November 13, 2020
Clinical practice guidelines update—Human Immunodeficiency Virus (HIV) and Hyperlipidemia Opens a new window (PDF) - November 6, 2020
HEDIS® telehealth tips Opens a new window (PDF) - November 2, 2020
Lead screening and reporting requirements in the District of Columbia Opens a new window (PDF) - October 30, 2020
Lead screening and reporting requirements in the District of Columbia Opens a new window (PDF) - October 27, 2020
Remind your patients to get their flu shots Opens a new window (PDF) - October 26, 2020
Pharmacy information for new enrollee transition Opens a new window (PDF) - October 23, 2020
Medicaid reform: MCO provider forum invite Opens a new window (PDF) - October 22, 2020
Site of care for outpatient physical, occupational, and speech therapy Opens a new window (PDF) - October 22, 2020
Home and portable oxygen therapy policy Opens a new window (PDF) - October 21, 2020
Non-obstetrical pelvic ultrasounds policy Opens a new window (PDF) - October 19, 2020
Adult providers clinical practice guidelines update Opens a new window (PDF) - October 16, 2020
Obstetrical ultrasound examinations policy Opens a new window (PDF) - October 9, 2020
Dental providers alert Opens a new window (PDF) - October 6, 2020
Dental quarterly Medicaid enrollment renewal letter Opens a new window (PDF) - October 6, 2020
Trump administration announces new phase 3 provider relief funding Opens a new window (PDF) - October 5, 2020
Continuity of care for beneficiaries in managed care and provider reimbursement Opens a new window (PDF) - October 1, 2020
Change of prior authorization requirements for certain procedure codes Opens a new window (PDF) - September 23, 2020
Health care delivery management administration Opens a new window (PDF) - September 11, 2020
Preventive health guideline updates — Asthma, tobacco use, and identification of childhood obesity Opens a new window (PDF) - September 11, 2020
Preventive health guideline updates — Asthma and tobacco use Opens a new window (PDF) - September 9, 2020
Introduction to Performant's retrospective outpatient services audit Opens a new window (PDF) - September 8, 2020
Medicaid-reimbursable telemedicine services Opens a new window (PDF) - August 21, 2020
Emergency services level of care review policy Opens a new window (PDF) - August 20, 2020
Drug formulary change Opens a new window (PDF) - July 30, 2020
Modifier 25 policy notice Opens a new window (PDF) - July 27, 2020
Annual maximum for Alliance enrollees will renew on January 1, 2021 Opens a new window (PDF) - July 23, 2020
Care gap changes to align with HEDIS measures Opens a new window (PDF) - July 17, 2020
Therapy multiple procedure reduction policy Opens a new window (PDF) - July 16, 2020
Prior authorization expiration dates extended Opens a new window (PDF) - July 1, 2020
Notice to enrollees under age 21 of scheduled, due, and overdue services Opens a new window (PDF) - June 29, 2020
Additional explanation of benefits (EOB) will appear on your remittance advices starting August 1, 2020 Opens a new window (PDF) - June 25, 2020
New seminar series on anti-racism and health disparities Opens a new window (PDF) - June 23, 2020
Process for verification of provider demographic information — AFC Management Services Opens a new window (PDF) - June 18, 2020
How to receive email alerts from AmeriHealth Caritas District of Columbia Opens a new window (PDF) - June 16, 2020
Updates to dental provider manual (PDF) - June 15, 2020
Health Guideline Update — Routine preventive services for children and adolescents (ages 2 (PDF) - June 15, 2020
Vaccines for children provider survey (PDF) - June 8, 2020
Pediatric preventive care and school health (PDF) - May 29, 2020
District of Columbia COVID-19 Hotline and COVID-19 Support Hub (PDF) - May 29, 2020
Site of care medical pharmacy (PDF) - May 29, 2020
Lowest cost site of care medical pharmacy policy (PDF) - May 5, 2020
Billing update for teledentistry encounters (PDF) - April 27, 2020
The Federal Communications Commission (FCC) has approved $200 million in telehealth funding for health care providers (PDF) - April 27, 2020
Temporary eligibility policy changes (PDF) - April 27, 2020
New CDC Symptom Checker tool (PDF) - April 27, 2020
Transportation on hold through June 1 for nonessential care (PDF) - April 10, 2020
Updated vaccine information statements (PDF) - April 10, 2020
New guidance concerning COVID-19 diagnosis coding (PDF) - April 3, 2020
Lowest cost site of care medical pharmacy policy (PDF) - April 3, 2020
Anesthesia services for gastrointestinal endoscopy policy notification (PDF) - March 26, 2020
Updated priorities for testing patients with suspected COVID-19 infection (PDF) - March 26, 2020
Recommendations for conserving the supply of personal protective equipment (PDF) - March 23, 2020
Children's National Hospital COVID-19 testing (PDF) - March 23, 2020
Formulary change update (PDF) - March 23, 2020
Limiting elective procedures due to coronavirus (PDF) - March 20, 2020
HIPAA telehealth (PDF) - March 18, 2020
Access and Availability to Care – Use of Telehealth During the COVID-19 Response Period (PDF) - March 18, 2020
Enrollee wellness center closed (PDF) - March 17, 2020
Provider notice on COVID-19 (PDF) - March 17, 2020
Telemedicine provider guide follow up (PDF) - March 13, 2020
Important Information Regarding COVID-19 (PDF) - March 13, 2020
Reminder concerning telehealth services (PDF) - March 12, 2020
ICD-10-CM official coding guidelines – supplement: coding encounters related to COVID-19 Coronavirus outbreak (PDF) - February 28, 2020
Coronavirus disease (COVID-19) (PDF)
2019
- July 30, 2019
Release of new physician resource: opioid use disorder e-learning module (PDF) - July 30, 2019
Update on pharmaceuticals requiring prior authorization (PDF) - April 16, 2019
The importance of race, ethnicity, and language data (PDF) - April 16, 2019
- Culturally and linguistically appropriate services (CLAS) and patient health (PDF)
- March 27, 2019
Maternal health seminar (PDF) - March 20, 2019
Prior authorization requirement change (PDF) - March 20, 2019
Social determinants of health provider training (PDF) - March 14, 2019
Providing health care to culturally and ethnically diverse populations (PDF) - February 28, 2019
Statement on the Use of Opioids in the Treatment of Dental Pain (PDF) - February 11, 2019
All providers with a Medicaid ID must recertify ID every five years (PDF)