Key Updates
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
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 uploadsCommercialSeptember 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 — ProfessionalCommercialSeptember 1, 2025
Reimbursement policy reminder: Laboratory and Venipuncture Services — Professional and FacilityMedicare AdvantageSeptember 1, 2025
Elevate your practice efficiency with electronic prescriber toolsMedicaidSeptember 1, 2025
RSV immunization: key to infant healthMedicaidAugust 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, Osenvelt, 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 healthMedicaidAugust 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
Enhancing accuracy in evaluation and management services claimsCommercialAugust 1, 2025
Reminder: submitting facility claimsCommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicaidJuly 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 networkCommercialMedicare AdvantageMedicaidJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialMedicare AdvantageMedicaidJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataMedicaidJuly 1, 2025
Enhanced personalized match: improving the care provider search for membersCommercialJuly 1, 2025
Streamline BlueCard claims: Get the latest tips and best practicesCommercialMedicare AdvantageMedicaidJuly 1, 2025
Enhanced efficiency in dispute handlingCommercialJuly 1, 2025
Benefits of being a Direct HMO providerCommercialJuly 1, 2025
Essential tips for accurate BlueCard claims