Highlights

Key Updates

Policy UpdatesMedicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series


What's New

Recent Updates

Policy Updates Medical Policy & Clinical GuidelinesCommercialFebruary 18, 2025

MCG Care Guidelines 29th edition

Policy UpdatesMedicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

Quality Management Optimizing HEDIS & STARSCommercialFebruary 11, 2025

Developmental screening in the first three years of life

Quality Management Optimizing HEDIS & STARSCommercialFebruary 11, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Quality Management Optimizing HEDIS & STARSCommercialFebruary 11, 2025

Chlamydia Screening (CHL) 2025

Quality Management Optimizing HEDIS & STARSCommercialFebruary 10, 2025

Colorectal Cancer Screening (COL-E) 2025

Administrative Digital SolutionsCommercialFebruary 4, 2025

Expansion of Carelon Medical Benefits Management, Inc. programs

Policy Updates Reimbursement PoliciesCommercialFebruary 1, 2025

New reimbursement policy: Place of Service — Professional

Products & Programs Federal Employee Program (FEP)CommercialFebruary 1, 2025

Corrected claim guidance for the Federal Employee Program®

AdministrativeCommercialMedicare AdvantageFebruary 1, 2025

New Communication Center added to Availity Essentials

Policy Updates Medical Policy & Clinical GuidelinesCommercialFebruary 1, 2025

Clinical Criteria updates for specialty pharmacy

Quality ManagementCommercialFebruary 1, 2025

Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)

Products & Programs PharmacyCommercialFebruary 1, 2025

Pharmacy information available on our provider website

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Products & Programs PharmacyCommercialJanuary 27, 2025

Key formulary updates: effective January 1, 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 22, 2025

Breast Cancer Screening (BCS-E) 2025

Quality ManagementCommercialJanuary 22, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 21, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 21, 2025

Controlling High Blood Pressure (CBP)

Quality ManagementCommercialJanuary 17, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 16, 2025

Asthma Medication Ratio (AMR) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 16, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Products & Programs Federal Employee Program (FEP)CommercialJanuary 14, 2025

Authorization for post‑acute care services for FEP members

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 13, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 13, 2025

Colorectal Cancer Screening (COL‑E) 2025

Quality ManagementMedicare AdvantageJanuary 13, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 13, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 12, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 9, 2025

Advanced Illness and Frailty 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 9, 2025

Transition of Care (TRC) 2025

Quality ManagementMedicare AdvantageJanuary 8, 2025

Breast Cancer Screening (BCS-E) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 7, 2025

Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 6, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 6, 2025

HEDIS Desktop Reference Guide for Commercial 2025

Education & TrainingCommercialMedicare AdvantageJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

AdministrativeMedicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

Products & Programs Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

Products & Programs PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

Products & Programs PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

Administrative Digital SolutionsCommercialMedicare AdvantageDecember 30, 2024

Enhance patient coordination with Total Member View

Products & Programs PharmacyCommercialDecember 27, 2024

Weight management program overview

Quality ManagementCommercialDecember 26, 2024

HEDIS Well Child and Immunizations Coding Bulletin 2025

Quality Management Optimizing HEDIS & STARSCommercialDecember 24, 2024

HEDIS® Category II Coding Bulletin 2025

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025