New Policy for Ambetter

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Effective March 31, 2022: Clinical Policies 


Superior HealthPlan has updated certain clinical policies to ensure medical necessity to review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on March 31, 2022 at 12 AM. 


Policy 

  • Hospice 

    • Applicable Products - Ambetter 

    • Policy updates include: 

      • Revised forced vital capacity (FVC) in II.B.3.a from < 40% to < 30%

      • Revised II.F.b.3 from, “>33% lean body mass,” to, “loss of at least 10% lean body mass” 

  • Nerve Blocks and Neurolysis for Pain Management

    • Applicable Products - Medicaid, Ambetter 

    • Policy updates include: 

      • Revised policy title from “Nerve Blocks for Pain Management” to “Nerve Blocks and Neurolysis for Pain Management”

      • Added VII. Insufficient evidence to determine the safety and effectiveness of intraosseous radiofrequency nerve ablation of basivertebral nerve.


Get contracted with Ambetter through Agility Insurance Services Now! 

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