Highlights

Key Updates

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series


What's New

Recent Updates

AdministrativeHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 18, 2025

Guideline update for Carelon Medical Benefits Management, Inc.

Policy Updates Medical Policy & Clinical GuidelinesCommercialFebruary 18, 2025

Change to Prior Authorization Requirements

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

Change to Prior Authorization Requirements

Reimbursement policy update: Diagnostic Radiopharmaceuticals and Contrast MaterialsProfessional and Facility

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®

Products & Programs PharmacyCommercialFebruary 1, 2025

Pharmacy information available on our provider website

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

AdministrativeCommercialFebruary 1, 2025

Change to Prior Authorization Requirements

Medical records needed for accurate payment of certain facility inpatient claims

Policy Updates Reimbursement PoliciesMedicare AdvantageFebruary 1, 2025

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

Products & Programs PharmacyCommercialFebruary 1, 2025

Designated specialty pharmacy network updates

Quality ManagementCommercialFebruary 1, 2025

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

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Administrative Digital SolutionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 28, 2025

Enhance patient coordination with Total Member View

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

Administrative Digital SolutionsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 15, 2025

Availity Essentials maternity update for providers

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

Authorization for post‑acute care services for FEP members

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 14, 2025

You are invited: Indiana PathWays for Aging training

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

Behavioral HealthCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 1, 2025

Comprehensive, holistic care for obstructive sleep apnea

AdministrativeMedicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

Policy Updates Medical Policy & Clinical GuidelinesCommercialJanuary 1, 2025

Change to Prior Authorization Requirements

Medical Policies and Clinical Guidelines updates — December 2024

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