Highlights

Key Updates

Policy Updates Reimbursement PoliciesMedicaidNovember 15, 2024

Targeted rate increase: update

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 24, 2024

Time to prepare for HEDIS medical record review

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!


What's New

Recent Updates

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

Policy Updates Reimbursement PoliciesMedicaidNovember 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

Personalized Match update

AdministrativeCommercialNovember 1, 2024

Welcome to the Pathway HMO Network

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Policy UpdatesMedicaidOctober 29, 2024

Clinical Criteria updates

Effective January 30, 2025

Quality ManagementMedicare AdvantageMedicaidOctober 29, 2024

HEDIS Measure Tips — Appropriate Treatment for Upper Respiratory Infection (URI) 2025

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 24, 2024

Time to prepare for HEDIS medical record review

Quality ManagementMedicaidOctober 24, 2024

Provider: CAHPS awareness

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 23, 2024

HEDIS Measure Tips — Appropriate Testing for Pharyngitis (CWP) 2025

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 22, 2024

HEDIS Measure Tips — Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageOctober 18, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective November 23, 2024

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder

Education & Training WebinarsMedicaidOctober 14, 2024

You are invited: Lead poisoning prevention in children

Policy Updates Prior AuthorizationMedicaidOctober 10, 2024

Prior authorization requirement changes

Effective February 1, 2025

Policy UpdatesCommercialOctober 9, 2024

Provider transparency update

Quality ManagementCommercialMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

HEDIS Measure Tips — Adults’ Access to Preventive/Ambulatory Health Services (AAP) 2025

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

AdministrativeCommercialOctober 2, 2024

Reimbursement policy updates for facilities

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

Administrative Digital SolutionsMedicare AdvantageOctober 1, 2024

Introducing the Care Provider Recognition Program from Anthem

Policy Updates Reimbursement PoliciesMedicare AdvantageOctober 1, 2024

Clarification to reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs PharmacyCommercialOctober 1, 2024

Pharmacy information available on our provider website

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 1, 2024

HEDIS medical record submission made easier with our Remote EMR Access service

AdministrativeCommercialOctober 1, 2024

National Accounts 2025 precertification list

AdministrativeCommercialOctober 1, 2024

Change in claims administration for Butte County schools