CommercialMedicare AdvantageMedicaidJanuary 1, 2025

January 2025 Provider Newsletter

Featured Articles

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 24, 2024

Time to prepare for HEDIS medical record review

Education & TrainingCommercialMedicare AdvantageMedicaidJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Digital SolutionsCommercialMedicaidDecember 24, 2024

Availity Essentials maternity update for providers

AdministrativeCommercialMedicare AdvantageMedicaidDecember 3, 2024

California DxF provider participation and accessing data for Anthem members

Administrative

AdministrativeCommercialJanuary 1, 2025

University of California PPO plans — injectable drug pre‑certification requirements

AdministrativeMedicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

AdministrativeCommercialJanuary 1, 2025

Change in claims administration for Butte County schools

AdministrativeCommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information

Digital SolutionsCommercialMedicare AdvantageMedicaidDecember 30, 2024

Enhance patient coordination with Total Member View

Behavioral Health

Behavioral HealthMedicaidJanuary 1, 2025

Long‑Term Services and Supports provider site visits

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaidJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Education & TrainingMedicare AdvantageMedicaidDecember 26, 2024

Prefix required on claim submissions

Policy Updates

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 19, 2024

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

Products & Programs

Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025

PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025

PharmacyMedicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

CABC-CDCRCM-074612-24

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).