Keeping up with regulatory and procedural changes is essential for healthcare providers. This update covers key developments, including Aetna’s new credentialing requirement for individual nurse practitioners, changes in reimbursement and precertification policies, and compliance with provider access standards.
Other significant updates include CMS’s 2025 institutional provider enrollment fee adjustment, a new reimbursement mandate for Carelon Behavioral Health outpatient services, and new prior authorization requirements for medical specialty drugs under 1199SEIU. Additionally, Emblem Health is introducing automated provider data updates via CAQH, streamlining credentialing processes.
Brand updates are also on the horizon, with new logos for NYSHIP, The Empire Plan, and the Student Employee Health Plan. Plus, if you’re looking to stay ahead in compliance and best practices, you can earn CEU credits with WCH Insights.
Stay informed and ensure your practice is aligned with the latest industry requirements.
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