CommercialMedicare AdvantageJanuary 1, 2025

January 2025 Provider Newsletter

Featured Articles

Education & TrainingCommercialMedicare AdvantageJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Quality ManagementCommercialMedicare AdvantageOctober 24, 2024

Time to prepare for HEDIS medical record review

Administrative

AdministrativeCommercialJanuary 1, 2025

Drug fee schedule update

AdministrativeCommercialMedicare AdvantageJanuary 1, 2025

New year, new labs: LabCorp and Quest Diagnostics now in‑network for Colorado plans

AdministrativeMedicare AdvantageJanuary 1, 2025

D‑SNP members can earn rewards by participating in select healthcare activities

AdministrativeCommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information

Digital SolutionsCommercialMedicare AdvantageDecember 30, 2024

Enhance patient coordination with Total Member View

Education & Training

Education & TrainingCommercialMedicare AdvantageJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Education & TrainingCommercialJanuary 1, 2025

Material adverse change

Prefix required on claim submissions

Education & TrainingMedicare AdvantageDecember 24, 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

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

Medical Policy & Clinical GuidelinesCommercialDecember 5, 2024

Material adverse change

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 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025

PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

PharmacyCommercialDecember 27, 2024

Weight management program overview

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

COBCBS-CRCM-074613-24

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