Key Updates
CommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar series
Recent Updates
CommercialFebruary 18, 2025
MCG Care Guidelines 29th editionCommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025CommercialFebruary 10, 2025
Colorectal Cancer Screening (COL-E) 2025CommercialFebruary 4, 2025
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialFebruary 1, 2025
Medical Policy and Clinical Guideline updates May 1, 2025CommercialMedicare AdvantageFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialFebruary 1, 2025
Clinical Criteria updates for specialty pharmacy are availableEffective May 1, 2025
CommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Ensuring accurate and timely claims processing: essential tips for gatekeeper plansCommercialFebruary 1, 2025
Medical records needed for accurate payment of certain facility inpatient claimsCommercialFebruary 1, 2025
Designated specialty pharmacy network updatesCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)Medicare AdvantageJanuary 28, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025CommercialJanuary 22, 2025
Breast Cancer Screening (BCS-E) 2025CommercialJanuary 22, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025CommercialJanuary 21, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 21, 2025
Controlling High Blood Pressure (CBP)CommercialJanuary 17, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 16, 2025
Asthma Medication Ratio (AMR) 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 16, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 14, 2025
Authorization for post‑acute care services for FEP membersMedicare AdvantageJanuary 13, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025Medicare AdvantageJanuary 13, 2025
Colorectal Cancer Screening (COL‑E) 2025Medicare AdvantageJanuary 13, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 13, 2025
Medication Adherence 2025Medicare AdvantageJanuary 12, 2025
Medication Adherence 2025Medicare AdvantageJanuary 9, 2025
Advanced Illness and Frailty 2025Medicare AdvantageJanuary 9, 2025
Transition of Care (TRC) 2025Medicare AdvantageJanuary 8, 2025
Breast Cancer Screening (BCS-E) 2025Medicare AdvantageJanuary 7, 2025
Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025Medicare AdvantageJanuary 6, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 6, 2025
HEDIS Desktop Reference Guide for Commercial 2025CommercialMedicare AdvantageJanuary 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingMedicare AdvantageJanuary 1, 2025
Announcing Health Perks — earn rewards for your healthcare activitiesCommercialJanuary 1, 2025
Introducing Coupe Health — quality care with clear pricing and no upfront paymentsCommercialJanuary 1, 2025
Update demographics: ensure directory accuracy for Open EnrollmentCommercialJanuary 1, 2025
CAA: Providers required to verify online provider directory informationCommercialJanuary 1, 2025
Georgia Medical Policy and Clinical Guideline updates — January 8, 2025CommercialJanuary 1, 2025
New year, new labs: LabCorp and Quest Diagnostics now in‑network for Georgia plansCommercialJanuary 1, 2025
2025 FEHB and PSHB information available onlineMedicare AdvantageJanuary 1, 2025
Kroger Specialty Pharmacy acquisition