Staying compliant with evolving regulations is crucial for healthcare providers.This update highlights New York Medicaid’s Compliance Program requirements, ensuring providers meet new obligations.Medicare Advantage is also adjusting prior authorization rules for outpatient therapy and chiropractic services, impacting patient access and administrative workflows.
Other major updates include the GEHA member transition to UMR, upcoming medical plan drug lists and policy changes, and important pharmacy updates from Aetna. Providers should be aware of the Claim and Code Review Program (CCRP) update, introducing new Aetna edits effective March 1, 2025, along with Humana’s latest claim processing adjustments.
Additionally, a temporary extension has been granted for audio-only telehealth services through early 2025, offering continued flexibility for virtual care.
These changes may affect billing, compliance, and patient management, making it essential to stay informed and prepared.
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