Key Updates
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 2, 2025
Precertification/prior authorization requirement changes
Effective June 1, 2025
CommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity Essentials
CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiency
Recent Updates
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines UpdateEffective May 25, 2025
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 21, 2025
Clinical Utilization Management Criteria updateHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 21, 2025
New preapproval requirements for coronary artery catheter placement proceduresMedicare AdvantageApril 18, 2025
New specialty pharmacy medical step therapy requirementEffective June 1, 2025
Hercessi
Medicare AdvantageApril 18, 2025
Specialty pharmacy preapproval list updateEffective August 1, 2025
Jubbonti; Wyost
CommercialMedicare AdvantageApril 16, 2025
Provider Training Opportunity: You are invited: strategies for enhancing cardiovascular care and managementMedicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsCommercialApril 10, 2025
Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates, May 2025Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 7, 2025
FAQ for Care CentralMedicare AdvantageApril 2, 2025
HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 2, 2025
Precertification/prior authorization requirement changesEffective June 1, 2025
CommercialMedicare AdvantageApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingCommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsCommercialMarch 27, 2025
Change to Prior Authorization Requirements
Specialty pharmacy updates — April 2025Medicare AdvantageMarch 27, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 27, 2025
Medicaid‑covered crisis care: The impact of Indiana's Mobile Crisis Teams under the 988 initiativeHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 25, 2025
Prior authorization updateEffective July 1, 2025
Codes 62380 and 27280
Medicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 25, 2025
Anthem will delegate care management to Carelon Health, Inc.Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 14, 2025
Prior authorization requirement changesEffective May 1, 2025
CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 12, 2025
Resources to support diverse patients and communitiesMedicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
Reminder: provider data attestationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
New federal rule transforms confidentiality protocols for SUD patient recordsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
Person-centered thinking hybrid trainingCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
New Communication Center added to Availity EssentialsCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsMedicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptionsEffective April 1, 2025
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 28, 2025
Frenectomy prior authorization updateCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiencyMedicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025Medicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 21, 2025
Reminder of claims submissions for FQHCs/RHCs for T1015CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education creditsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 20, 2025
Important update for HCBS providers: guidelines for using alternative EVV vendorsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 20, 2025
MCG Care Guidelines 29th editionEffective May 1, 2025
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 18, 2025
Guideline update for Carelon Medical Benefits Management, Inc.CommercialFebruary 18, 2025
Change to Prior Authorization Requirements
MCG Care Guidelines 29th editionEffective June 1, 2025