Highlights

Key Updates

Administrative Digital SolutionsCommercialMedicaidDecember 24, 2024

Availity Essentials maternity update for providers

Education & TrainingMedicaidDecember 3, 2024

Guidance for blood lead level screening of young children

AdministrativeCommercialMedicare AdvantageMedicaidDecember 3, 2024

California DxF provider participation and accessing data for Anthem members

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 24, 2024

Time to prepare for HEDIS medical record review


What's New

Recent Updates

Education & TrainingMedicare AdvantageMedicaidDecember 26, 2024

Prefix required on claim submissions

Quality ManagementCommercialDecember 26, 2024

HEDIS Well Child and Immunizations Coding Bulletin 2025

Administrative Digital SolutionsCommercialMedicaidDecember 24, 2024

Availity Essentials maternity update for providers

Quality Management Optimizing HEDIS & STARSCommercialDecember 24, 2024

HEDIS CAT II Coding Bulletin 2025

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 19, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Education & TrainingMedicaidDecember 3, 2024

Guidance for blood lead level screening of young children

AdministrativeCommercialDecember 3, 2024

Outpatient system updates for 2025

AdministrativeCommercialDecember 3, 2024

Professional system updates for 2025

AdministrativeCommercialMedicare AdvantageMedicaidDecember 3, 2024

California DxF provider participation and accessing data for Anthem members

Behavioral HealthCommercialDecember 1, 2024

BlueCard Program useful tips

AdministrativeCommercialDecember 1, 2024

Case Management program

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

AdministrativeCommercialDecember 1, 2024

Reminder: Direct HMO is coming January 2025

Products & Programs PharmacyCommercialDecember 1, 2024

Pharmacy information available online

AdministrativeCommercialDecember 1, 2024

Coordination of care

Products & Programs PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

Products & Programs PharmacyCommercialDecember 1, 2024

Paragon Healthcare joins our medical specialty pharmacy provider network in 2025

Products & Programs Federal Employee Program (FEP)CommercialDecember 1, 2024

FEP excited to join PSHB program in 2025

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

AdministrativeCommercialDecember 1, 2024

Appropriate 911/emergency care procedures

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

Behavioral HealthCommercialDecember 1, 2024

Do you offer telehealth services? Let us know!

Behavioral HealthCommercialDecember 1, 2024

CAA: Maintain your online provider directory information

Behavioral HealthCommercialDecember 1, 2024

Find answers to BlueCard questions

Behavioral HealthCommercialMedicare AdvantageDecember 1, 2024

Comprehensive, holistic care for obstructive sleep apnea

Quality Management Optimizing HEDIS & STARSMedicare AdvantageNovember 26, 2024

HEDIS Category II Coding Bulletin 2025

Products & Programs PharmacyMedicare AdvantageNovember 19, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

AdministrativeMedicaidNovember 15, 2024

Targeted rate increase: update

AdministrativeMedicare AdvantageNovember 15, 2024

California 2025 Medicare Advantage plan changes

AdministrativeMedicaidNovember 13, 2024

Updated provider manual now available

Policy UpdatesMedicaidNovember 6, 2024

Clinical Criteria updates

Effective February 9, 2025

Policy UpdatesCommercialNovember 6, 2024

Cost transparency

Policy Updates Prior AuthorizationMedicaidNovember 5, 2024

Prior authorization requirement changes

Effective March 1, 2025

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality

Products & Programs PharmacyMedicaidNovember 1, 2024

Bayer announces withdrawal of Aliqopa® (copanlisib)

AdministrativeCommercialNovember 1, 2024

Welcome to the Pathway HMO Network

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics