Community Health Choice policy updates
Track new and updated Community Health Choice policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Clinician Administered Drugs Site of Care Policy | Communityhealthchoice | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2025 |
| Separate Reimbursement of Certain Inpatient High-Cost Drug and Biologics (HCCADs) | Communityhealthchoice | Reimbursement | — | Modified | Jun 2, 2025 |
| Prior Authorization Criteria for Kisunla | Communityhealthchoice | Clinical | Pharmacy & Specialty Drugs | Modified | Feb 1, 2025 |
| Prior Authorization Criteria for Imdelltra (tarlatamab-dlle) | Communityhealthchoice | Clinical | Pharmacy & Specialty Drugs | Modified | Nov 1, 2024 |
| SevenFact Criteria for Coverage | Communityhealthchoice | Clinical | Hematology/Oncology | Modified | Jul 1, 2024 |
| Trogarzo (ibalizumab-uiyk) Coverage Criteria | Communityhealthchoice | Clinical | Pharmacy & Specialty Drugs | Modified | May 1, 2024 |
| Tocilizumab Preferred Product Policy | Communityhealthchoice | Clinical | Pharmacy & Specialty Drugs | Modified | — |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.