Key Updates
Medicare AdvantageSeptember 12, 2025
Skin substitutes: improving prior authorization for effective wound treatment
CommercialSeptember 12, 2025
You are invited: Every Measure Counts webinar
Medicare AdvantageSeptember 11, 2025
Skin substitutes and prior authorizations: FAQ
Medicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploads
CommercialMedicare AdvantageMedicaidAugust 25, 2025
Enhance your skills with expanded billing and coding training
Recent Updates
CommercialSeptember 15, 2025
Streamlining your appeals process for inpatient and post‑acute facilitiesMedicare AdvantageSeptember 12, 2025
Skin substitutes: improving prior authorization for effective wound treatmentCommercialSeptember 12, 2025
You are invited: Every Measure Counts webinarMedicare AdvantageSeptember 11, 2025
Precertification/prior authorization requirement changesEffective January 1, 2026
Medicare AdvantageSeptember 11, 2025
Skin substitutes and prior authorizations: FAQMedicare AdvantageSeptember 5, 2025
Anthem expands specialty pharmacy precertification listMedicaidSeptember 2, 2025
Carelon Medical Benefits Management, Inc. updatesEffective on December 5, 2025
Medicare AdvantageSeptember 2, 2025
Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective February 7, 2026
MedicaidSeptember 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
Reimbursement policy update: After‑hours, Emergency, and Miscellaneous E/M Services — ProfessionalCommercialSeptember 1, 2025
Direct HMO offers Pathway HMO members access to PPO network physiciansMedicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploadsMedicare AdvantageSeptember 1, 2025
Medication safety: Reducing risks with thoughtful prescribing and monitoringCommercialMedicare AdvantageMedicaidSeptember 1, 2025
Reminder: meet and confer requirement removed for Anthem Blue Cross facility‑type providersMedicaidAugust 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
SUD confidentiality protections for membersCommercialAugust 1, 2025
Support your patients with the CarelonRx, Inc. and Lark Weight Management ProgramCommercialMedicare AdvantageMedicaidAugust 1, 2025
You are invited: immunization measures webinarCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthCommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicaidAugust 1, 2025
Updated provider manual is now availableCommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patientsCommercialAugust 1, 2025
Reminder: submitting facility claimsCommercialAugust 1, 2025
Enhancing accuracy in evaluation and management services claimsMedicaidJuly 29, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
MedicaidJuly 28, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective October 29, 2025
Medicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialMedicare AdvantageMedicaidJuly 22, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 21, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideMedicaidJuly 18, 2025
Access free health education and interpreter servicesCommercialJuly 7, 2025
Direct HMO: PPO providers in an HMO network