Key Updates
CommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar series
MedicaidFebruary 1, 2025
Medi‑Cal Managed Care for Kids & Teens provider training
Recent Updates
CommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025CommercialFebruary 10, 2025
Colorectal Cancer Screening (COL-E) 2025MedicaidFebruary 3, 2025
Prior authorization updates for medications billed under the medical benefitCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialMedicare AdvantageMedicaidFebruary 1, 2025
New Communication Center added to Availity EssentialsMedicaidFebruary 1, 2025
Medi‑Cal Managed Care for Kids & Teens provider trainingCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Pharmacy information available on our websiteCommercialFebruary 1, 2025
Action required for HMO medical groups — submit HMO ancillary informationCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)MedicaidJanuary 29, 2025
Alcohol and drug screening, assessment, brief interventions, and referral to treatmentMedicare AdvantageJanuary 28, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025CommercialJanuary 22, 2025
Breast Cancer Screening (BCS-E) 2025CommercialJanuary 22, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025CommercialJanuary 21, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 21, 2025
Controlling High Blood Pressure (CBP)CommercialJanuary 16, 2025
Asthma Medication Ratio (AMR) 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 16, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 15, 2025
Weight management program overviewMedicare AdvantageJanuary 13, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025Medicare AdvantageJanuary 13, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025Medicare AdvantageJanuary 13, 2025
Colorectal Cancer Screening (COL‑E) 2025CommercialJanuary 13, 2025
Medication Adherence 2025Medicare AdvantageJanuary 12, 2025
Medication Adherence 2025CommercialJanuary 10, 2025
Help for members impacted by wildfires in Southern CaliforniaCommercialJanuary 10, 2025
Adult Immunization Status (AIS‑E) 2025Medicare AdvantageJanuary 9, 2025
Advanced Illness and Frailty 2025Medicare AdvantageJanuary 9, 2025
Transition of Care (TRC) 2025Medicare AdvantageJanuary 8, 2025
Breast Cancer Screening (BCS-E) 2025MedicaidJanuary 8, 2025
New specialty pharmacy medical step therapy requirementsMedicare AdvantageJanuary 7, 2025
Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025MedicaidJanuary 7, 2025
Prior authorization updates for medications billed under the medical benefitEffective May 1, 2025
Kisunla and Piasky
Medicare AdvantageJanuary 6, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 6, 2025
HEDIS Desktop Reference Guide for Commercial 2025MedicaidJanuary 3, 2025
Prior authorization updates for medications billed under the medical benefitEffective May 1, 2025
Alyglo, Simlandi, and Winrevair
CommercialMedicare AdvantageMedicaidJanuary 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingCommercialJanuary 1, 2025
CAA: Providers required to verify online provider directory informationCommercialJanuary 1, 2025
Change in claims administration for Butte County schoolsMedicaidJanuary 1, 2025
Long‑Term Services and Supports provider site visitsMedicare AdvantageJanuary 1, 2025
Announcing Health Perks — earn rewards for your healthcare activitiesMedicare AdvantageJanuary 1, 2025
Kroger Specialty Pharmacy acquisitionCommercialJanuary 1, 2025
University of California PPO plans — injectable drug pre‑certification requirementsCommercialJanuary 1, 2025
2025 FEHB and PSHB information available onlineMedicare AdvantageDecember 31, 2024
Important information about specialty prescriptions