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Effective August 1, 2024: Clinical Policies

Date: 05/01/24

Superior HealthPlan has added and updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on August 1, 2024, at 12:00AM.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Home Ventilators

(MC.CP.MP.184)

Wellcare By Allwell (Medicare)

New Policy Overview:

  • Medical necessity criteria for noninvasive and invasive home ventilators
  • Timeframes and documentation for continued use
  • Medical necessity criteria for a second or back up ventilator
  • Policy Background
  • Coding implications

Omisirge

(MC.CP.MP.249)

Wellcare By Allwell (Medicare)

New Policy Overview:

  • Medical necessity criteria for Omisirge (Omidubicel-onlv)
  • Policy Background
  • Coding implications

 

Outpatient Oxygen Use

(MC.CP.MP.190)

Wellcare By Allwell (Medicare)

New Policy Overview:

  • Medical necessity criteria and guidelines for Oxygen Therapy
  • Reauthorization of oxygen therapy medical necessity criteria
  • Policy Background
  • Coding implications

 

Peripheral Nerve Blocks

(MC.CP.MP.170)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Added criteria III.B. regarding genicular nerve blocks

 

Transplant Service Documentation Requirements

(MC.CP.MP.247)

Wellcare By Allwell (Medicare)

New Policy Overview:

  • Determination of medical necessity criteria for transplant procedures based on documentation
  • Listing of information for initial and subsequent transplant requests
  • Policy Background
  • Coding implications

 

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

For questions or additional information, please contact Wellcare By Allwell Provider Services at 1-877-391-5921.