Highlights

Key Updates

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers


What's New

Recent Updates

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 3, 2025

Quarterly pharmacy formulary change notice

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Clinical Criteria updates

Effective August 3, 2025

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

National Drug Codes (NDCs) are required for professional and outpatient claims

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

State communication: Virginia’s Medicaid Preferred Drug List (PDL)/ Common Core Formulary

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experience

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Anthem Blue Cross and Blue Shield VA Precertification/Prior Authorization list change notification July 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Enroll with Availity to verify your provider data

Products & Programs Long-Term Services & SupportsHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Help shape the LTSS workforce: input needed on recruitment and hiring

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Streamlining behavioral health authorizations via Availity Essentials

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

Combat diabetes: Close the statin therapy gap for better heart health

Guideline Updates Reimbursement PoliciesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Reimbursement Policy Update: Abortion (Termination of Pregnancy)

Education & Training WebinarsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 30, 2025

For hospitals and facilities: introducing a new foster care specialty plan

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 30, 2025

Announcing a new Foster Care Specialty Plan

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

Effective November 1, 2025
Axtle, Bizengri, and Bynfezia pen

Products & ProgramsAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 25, 2025

Anthem welcomes CareBridge

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 23, 2025

Essential information for providers: understanding Medicare Advantage group retiree plans

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 17, 2025

You are invited: provider coding education

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Guideline Updates Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 9, 2025

Prior authorization requirement changes

Effective August 1, 2025

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 6, 2025

July 1, 2025 Implementation of New Cardinal Care Managed Care Contract

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 4, 2025

National Drug Codes (NDC) are required for outpatient claims

Guideline UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialJune 2, 2025

Specialty pharmacy updates: June 2025

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

VA precertification/prior authorization list change notification June 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Update to claims system for global surgical procedures for professional providers

Quality ManagementHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 1, 2025

Member support resource — Complex Case Management program

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Quality ManagementHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 1, 2025

Shared empowerment — knowing member rights and responsibilities

Quality ManagementHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 1, 2025

Efficacy through efficiency — emphasizing utilization management

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Guideline UpdatesAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Clinical Criteria updates for specialty pharmacy are available

Effective September 1, 2025

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Education & Training WebinarsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 1, 2025

Registration is now available for our upcoming CME webinar on Integrating Cancer Care

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 1, 2025

Submitting BH authorizations in Availity Essentials

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 28, 2025

Clinical Criteria updates

Effective June 30, 2025

Quality ManagementHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 27, 2025

Combating congenital syphilis: essential steps for healthcare providers

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 27, 2025

Boost your roster submission skills with Availity Essentials

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 21, 2025

2025 Clinical Practice Guidelines

Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective June 25, 2025

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Ahzantive, Enzeevu, Opuviz, Pavblu, and Yesafili