Key Updates
Medicare AdvantageSeptember 12, 2025
Skin substitutes: improving prior authorization for effective wound treatment
Effective January 1, 2026
CommercialSeptember 12, 2025
You are invited: Every Measure Counts webinar
Medicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploads
Recent Updates
Medicare AdvantageOctober 1, 2025
Medicare preferred continuous glucose monitorsCommercialOctober 1, 2025
2025 BCBS Axis® Provider Insights refreshMedicare AdvantageOctober 1, 2025
Outpatient facility editing system update for recovery room claimsCommercialOctober 1, 2025
GeoBlue member care: best practices for providersCommercialOctober 1, 2025
Important update: required documentation for select ePA requestsCommercialOctober 1, 2025
Your feedback makes a difference: participate in our 2025 Provider Satisfaction SurveyMedicare AdvantageOctober 1, 2025
Medicare Advantage outpatient facility revenue code billing requirements — facilityCommercialOctober 1, 2025
Driving quality care through provider transparencyCommercialOctober 1, 2025
Clearer care costs through transparency toolsCommercialMedicare AdvantageMedicaidOctober 1, 2025
Enhance efficiency and the check‑in experience with digital member ID cardsCommercialMedicare AdvantageMedicaidOctober 1, 2025
Important HEDIS supplemental data submission dates and deadlinesCommercialOctober 1, 2025
Updated Commercial provider manual available, effective January 1, 2026CommercialOctober 1, 2025
Update to claims system: global surgical proceduresMedicare AdvantageSeptember 26, 2025
Prior authorization requirement updates — Carelon Medical Benefits ManagementEffective January 1, 2026
Medicare AdvantageSeptember 25, 2025
Carelon Medical Benefits Management, Inc. updatesEffective November 15, 2025
CommercialMedicare AdvantageMedicaidSeptember 25, 2025
Clinical UM attestation and use guide — FAQMedicare AdvantageSeptember 16, 2025
Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective January 10, 2026
Medicare AdvantageSeptember 16, 2025
Prior authorization requirement updates for Carelon Medical Benefits ManagementEffective January 1, 2026
CommercialSeptember 15, 2025
Streamlining your appeals process for inpatient and post‑acute facilitiesMedicare AdvantageSeptember 12, 2025
Skin substitutes: improving prior authorization for effective wound treatmentEffective January 1, 2026
CommercialSeptember 12, 2025
You are invited: Every Measure Counts webinarMedicare AdvantageSeptember 11, 2025
Precertification/prior authorization requirement changesEffective January 1, 2026
Medicare AdvantageSeptember 5, 2025
Anthem expands specialty pharmacy precertification listEffective January 1, 2026
Emrelis and Penpulimab‑kcqx
MedicaidSeptember 2, 2025
Carelon Medical Benefits Management, Inc. updatesEffective on December 5, 2025
CommercialMedicare AdvantageMedicaidSeptember 1, 2025
Reminder: meet and confer requirement removed for Anthem Blue Cross facility‑type providersMedicare AdvantageSeptember 1, 2025
Medication safety: Reducing risks with thoughtful prescribing and monitoringMedicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploadsMedicaidSeptember 1, 2025
RSV immunization: key to infant healthMedicare AdvantageSeptember 1, 2025
Elevate your practice efficiency with electronic prescriber toolsCommercialSeptember 1, 2025
Reimbursement policy reminder: Laboratory and Venipuncture Services — Professional and FacilityCommercialSeptember 1, 2025
Direct HMO offers Pathway HMO members access to PPO network physiciansCommercialSeptember 1, 2025
Reimbursement policy update: After‑hours, Emergency, and Miscellaneous E/M Services — ProfessionalMedicaidAugust 26, 2025
Carelon Medical Benefits Management, Inc. updatesEffective November 28, 2025
Cardiovascular
CommercialMedicare AdvantageMedicaidAugust 25, 2025
Enhance your skills with expanded billing and coding trainingMedicare AdvantageAugust 25, 2025
Anthem expands specialty pharmacy precertification listsEffective December 1, 2025
Avtozma, Osenvelt, Ospomyv, Stoboclo, and Xbryk
Medicare AdvantageAugust 22, 2025
2025 Medicare Advantage California EAE DSNP Fact Sheet Directly Contracted ProvidersMedicare AdvantageAugust 21, 2025
Medication safety: Clinical strategies for EMR monitoring and preventionMedicaidAugust 18, 2025
Understanding the importance of monitoring EDI reportsMedicare AdvantageAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective November 15, 2025
CommercialMedicare AdvantageMedicaidAugust 14, 2025
PCP IDs may change as part of HMO redesignMedicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesMedicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesEffective December 1, 2025
MedicaidAugust 12, 2025
Carelon Medical Benefits Management, Inc. updatesGenetic Testing
MedicaidAugust 7, 2025
You are invited: provider coding educationMedicare AdvantageAugust 1, 2025
Expanded specialty pharmacy precertification listEffective November 1, 2025
Bomyntra, Conexxence, Imaav, Jobevne, Omlyclo, Qfitlia, Vyalev, and Jobevne
CommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patients