Highlights

Key Updates

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Education & TrainingMedicaidFebruary 1, 2025

Medi‑Cal Managed Care for Kids & Teens provider training


What's New

Recent Updates

Policy UpdatesMedicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

Quality Management Optimizing HEDIS & STARSCommercialFebruary 11, 2025

Developmental screening in the first three years of life

Quality Management Optimizing HEDIS & STARSCommercialFebruary 11, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Quality Management Optimizing HEDIS & STARSCommercialFebruary 11, 2025

Chlamydia Screening (CHL) 2025

Quality Management Optimizing HEDIS & STARSCommercialFebruary 10, 2025

Colorectal Cancer Screening (COL-E) 2025

Products & Programs PharmacyMedicaidFebruary 3, 2025

Prior authorization updates for medications billed under the medical benefit

Products & Programs Federal Employee Program (FEP)CommercialFebruary 1, 2025

Corrected claim guidance for the Federal Employee Program®

AdministrativeCommercialMedicare AdvantageMedicaidFebruary 1, 2025

New Communication Center added to Availity Essentials

Education & TrainingMedicaidFebruary 1, 2025

Medi‑Cal Managed Care for Kids & Teens provider training

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyCommercialFebruary 1, 2025

Pharmacy information available on our website

Products & Programs PharmacyCommercialFebruary 1, 2025

Action required for HMO medical groups — submit HMO ancillary information

Quality ManagementCommercialFebruary 1, 2025

Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)

Policy UpdatesMedicaidJanuary 30, 2025

Clinical Criteria updates

Effective May 8, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Products & Programs PharmacyCommercialJanuary 27, 2025

Key formulary updates: effective January 1, 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 22, 2025

Breast Cancer Screening (BCS-E) 2025

Quality ManagementCommercialJanuary 22, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 21, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 21, 2025

Controlling High Blood Pressure (CBP)

Quality Management Optimizing HEDIS & STARSCommercialJanuary 16, 2025

Asthma Medication Ratio (AMR) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 16, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Products & Programs PharmacyCommercialJanuary 15, 2025

Weight management program overview

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 13, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality ManagementMedicare AdvantageJanuary 13, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 13, 2025

Colorectal Cancer Screening (COL‑E) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 13, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 12, 2025

Medication Adherence 2025

AdministrativeCommercialJanuary 10, 2025

Help for members impacted by wildfires in Southern California

Quality ManagementCommercialJanuary 10, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 9, 2025

Advanced Illness and Frailty 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 9, 2025

Transition of Care (TRC) 2025

Quality ManagementMedicare AdvantageJanuary 8, 2025

Breast Cancer Screening (BCS-E) 2025

Products & Programs PharmacyMedicaidJanuary 8, 2025

New specialty pharmacy medical step therapy requirements

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 7, 2025

Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025

Products & Programs PharmacyMedicaidJanuary 7, 2025

Prior authorization updates for medications billed under the medical benefit

Effective May 1, 2025
Kisunla and Piasky

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 6, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 6, 2025

HEDIS Desktop Reference Guide for Commercial 2025

Products & Programs PharmacyMedicaidJanuary 3, 2025

Prior authorization updates for medications billed under the medical benefit

Effective May 1, 2025
Alyglo, Simlandi, and Winrevair

Education & TrainingCommercialMedicare AdvantageMedicaidJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

AdministrativeCommercialJanuary 1, 2025

Change in claims administration for Butte County schools

Behavioral HealthMedicaidJanuary 1, 2025

Long‑Term Services and Supports provider site visits

AdministrativeMedicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

Products & Programs PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

Products & Programs Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

Products & Programs PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions