Highlights

Key Updates

Policy UpdatesMedicaidApril 9, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 10, 2025

Policy Updates Prior AuthorizationMedicaidApril 4, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidFebruary 28, 2025

Update: Availity launches enhanced provider enrollment features for improved efficiency


What's New

Recent Updates

Policy UpdatesMedicaidApril 25, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 28, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines Update

Effective May 25, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidApril 21, 2025

2025 Clinical Practice Guidelines now available

Products & Programs Long-Term Services & SupportsMedicaidApril 18, 2025

Community-based adult services member ID prefix guidance

AdministrativeMedicaidApril 17, 2025

Improving maternal mental health: new screening protocols

Products & Programs PharmacyMedicare AdvantageApril 16, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

Products & Programs PharmacyMedicare AdvantageApril 16, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

Policy UpdatesMedicaidApril 9, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 10, 2025

Policy Updates Prior AuthorizationMedicaidApril 4, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Policy UpdatesMedicaidApril 3, 2025

Clinical Criteria updates

Effective July 7, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageApril 2, 2025

HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2025

Policy Updates Reimbursement PoliciesCommercialApril 1, 2025

Reimbursement policy updates for facilities

Education & TrainingCommercialMedicare AdvantageMedicaidApril 1, 2025

Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics

Policy Updates Prior AuthorizationMedicare AdvantageMarch 28, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Policy Updates Prior AuthorizationMedicare AdvantageMarch 26, 2025

Prior authorization requirement changes

Effective July 1, 2025

Policy UpdatesMedicaidMarch 21, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 30, 2025

Policy Updates Prior AuthorizationMedicaidMarch 20, 2025

Prior authorization requirement changes

Effective July 1, 2025

Products & Programs PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

AdministrativeCommercialMedicare AdvantageMedicaidMarch 19, 2025

Technical difficulties: My Diverse Patients

Quality Management Optimizing HEDIS & STARSMedicare AdvantageMarch 14, 2025

Controlling High Blood Pressure (CBP) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageMarch 14, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageMarch 11, 2025

Care for Older Adults (COA) 2025

Policy Updates Prior AuthorizationMedicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Products & Programs PharmacyMedicare AdvantageMarch 3, 2025

Important change to your patients’ specialty prescriptions

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidMarch 1, 2025

Reminder: provider data attestation

AdministrativeCommercialMarch 1, 2025

Practices improve patient access using NPs and PAs

Policy Updates Medical Policy & Clinical GuidelinesMedicaidMarch 1, 2025

Update to Clinical Practice Guidelines

AdministrativeCommercialMarch 1, 2025

Direct HMO now serving southern California counties

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

Changes in Postal Service Health Benefits for 2025

Education & TrainingCommercialMedicare AdvantageMedicaidFebruary 28, 2025

Resources to support diverse patients and communities

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidFebruary 28, 2025

Update: Availity launches enhanced provider enrollment features for improved efficiency

Policy UpdatesMedicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesMedicaidFebruary 26, 2025

Clinical Criteria updates

Effective May 28, 2025

AdministrativeMedicaidFebruary 24, 2025

Non-specialty mental health services Provider training

Quality Management Optimizing HEDIS & STARSMedicare AdvantageFebruary 21, 2025

Advanced Illness and Frailty Exclusions 2025

Education & Training WebinarsCommercialFebruary 21, 2025

Start 2025 with an easy way to earn continuing education credits

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Products & Programs PharmacyCommercialFebruary 20, 2025

Weight management program overview

Education & TrainingMedicaidFebruary 20, 2025

Initial Health Appointment Coding Guidance

Policy Updates Medical Policy & Clinical GuidelinesMedicaidFebruary 17, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

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