Effective January 1, 2025, the following update will be made to the list of preventive care services covered at no cost to members with Affordable Care Act (ACA) preventive benefits:
- Anemia screening: The U.S. Preventive Services Task Force (USPSTF) does not routinely recommend iron screening for pregnant women. Therefore, we are removing “anemia screening” from the Pregnant members section of our preventive care lists. A complete blood count (CBC) test will remain eligible for no cost-share for pregnant members.
- General health panel (CPT 80050): The USPSTF does not routinely recommend this panel’s lab components for the general population. We will cover this general health panel as a preventive benefit only in specific clinical settings, when a component of the lab could be considered preventive (e.g., for newborns for a thyroid stimulating hormone in context of newborn screening or a CBC for pregnant women).
Our preventive care list will be updated in January to reflect these changes.
12/4/2024
Our annual retrospective medical record review starts on December 4, 2024. In the next few months, you may receive medical record requests from Advantmed or Episource to complete this review. We appreciate your prompt response to all requests.
As a reminder, you are required to provide medical records for this review free of charge as part of your agreement with us. Learn more about our risk adjustment program, including best practices, tips and education resources.
12/4/2024
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