Highlights

Key Updates

Administrative Digital SolutionsCommercialMedicare AdvantageNovember 1, 2024

Roster Automation updates: roster download functionality

Quality ManagementCommercialMedicare AdvantageOctober 24, 2024

Time to prepare for HEDIS medical record review

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder


What's New

Recent Updates

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

AdministrativeMedicare AdvantageNovember 15, 2024

Colorado 2025 Medicare Advantage plan changes

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Administrative Digital SolutionsCommercialMedicare AdvantageNovember 1, 2024

Roster Automation updates: roster download functionality

Products & Programs PharmacyCommercialNovember 1, 2024

Material adverse change

Prior authorization updates for specialty pharmacy

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Material adverse change

Precertification List Change Notification — November 1, 2024

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy reminder: Multiple Surgery — Facility

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Material adverse change

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Material adverse change

Precertification List Change Notification — November 1, 2024

Codes J3393 and J3394

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

Quality ManagementMedicare AdvantageMedicaidOctober 29, 2024

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

Quality ManagementCommercialMedicare AdvantageOctober 24, 2024

Time to prepare for HEDIS medical record review

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 23, 2024

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

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 22, 2024

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

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder

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

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

AdministrativeCommercialOctober 1, 2024

National Accounts 2025 precertification list

AdministrativeCommercialOctober 1, 2024

Drug fee schedule update

Quality ManagementCommercialMedicare AdvantageOctober 1, 2024

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

Products & Programs PharmacyCommercialOctober 1, 2024

Pharmacy information available on our provider website

Products & Programs PharmacyCommercialOctober 1, 2024

Material adverse change

Prior authorization updates for specialty pharmacy — October 2024

Policy Updates Reimbursement PoliciesCommercialOctober 1, 2024

Material adverse change

Reimbursement policy update: Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service — Professional

Policy Updates Reimbursement PoliciesMedicare AdvantageOctober 1, 2024

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

AdministrativeCommercialOctober 1, 2024

Provider manual update available

Administrative Digital SolutionsMedicare AdvantageOctober 1, 2024

Introducing the Care Provider Recognition Program from Anthem

Products & Programs PharmacyMedicare AdvantageOctober 1, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Quality ManagementCommercialMedicare AdvantageOctober 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Policy UpdatesMedicare AdvantageSeptember 25, 2024

Carelon Medical Benefits Management, Inc. updates

Effective October 26, 2024

Policy Updates Prior AuthorizationMedicare AdvantageSeptember 24, 2024

Prior authorization requirement changes

Effective February 1, 2025

Policy Updates Prior AuthorizationMedicare AdvantageSeptember 23, 2024

Prior authorization requirement changes

Effective January 1, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageSeptember 23, 2024

Osteoporosis Management in Women Who Had a Fracture (OMW) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageSeptember 19, 2024

HEDIS Measure Tips — Osteoporosis Screening in Older Women (OSW) 2025

Education & TrainingMedicare AdvantageSeptember 16, 2024

Seamless advance care: MyDirectives digital tool for D-SNP members

Administrative Digital SolutionsCommercialMedicare AdvantageSeptember 12, 2024

Roster Automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageSeptember 10, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective October 10, 2024

Administrative Digital SolutionsCommercialMedicare AdvantageSeptember 4, 2024

Digital Provider Enrollment now available for additional provider types in Availity Essentials