Highlights

Key Updates

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 8, 2024

Reminder: Take action to protect infants from respiratory syncytial virus this season

Quality ManagementCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Time to prepare for HEDIS medical record review

Quality ManagementCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Time to prepare for HEDIS medical record review

Administrative Digital SolutionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Roster Automation updates: roster download functionality

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder


What's New

Recent Updates

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Products & Programs PharmacyCommercialNovember 18, 2024

Change to Prior Authorization Requirements

Specialty pharmacy updates — December 2024

AdministrativeMedicare AdvantageNovember 18, 2024

Indiana 2025 Medicare Advantage plan changes

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 15, 2024

Medical Policies, Clinical Utilization Management Guidelines update

Effective December 31, 2024

Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 14, 2024

Revised durable medical equipment (DME) rental list

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 11, 2024

Home health utilization management process

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 8, 2024

Reminder: Take action to protect infants from respiratory syncytial virus this season

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Provider: CAHPS awareness

Quality ManagementCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Time to prepare for HEDIS medical record review

Quality ManagementCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Time to prepare for HEDIS medical record review

Administrative Digital SolutionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 7, 2024

Roster Automation updates: roster download functionality

Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 5, 2024

Guideline update for Carelon Medical Benefits Management, Inc.

Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 4, 2024

Clinical Utilization Management Criteria update

Products & Programs Long-Term Services & SupportsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 4, 2024

Indiana PathWays for Aging claims testing period

Behavioral HealthCommercialNovember 1, 2024

Introducing a new Applied Behavior Analysis Provider Resource Guide

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Change to Prior Authorization Requirements

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

AdministrativeHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 1, 2024

Evaluation and management services correct coding

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

AdministrativeCommercialNovember 1, 2024

Personalized Match update

Policy Updates Reimbursement PoliciesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy reminder: Multiple Surgery — Facility

Products & Programs Federal Employee Program (FEP)CommercialNovember 1, 2024

Submit corrected claims electronically for the Federal Employee Program®

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Quality ManagementMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 29, 2024

HEDIS Measure Tips — Appropriate Treatment for Upper Respiratory Infection (URI) 2025

Products & Programs PharmacyCommercialOctober 24, 2024

Change to Prior Authorization Requirements

Specialty pharmacy updates — November 2024

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 23, 2024

HEDIS Measure Tips — Appropriate Testing for Pharyngitis (CWP) 2025

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 22, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective December 7, 2024

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 22, 2024

HEDIS Measure Tips — Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) 2025

Administrative Digital SolutionsCommercialOctober 21, 2024

Notification of authorization fax number changes

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder

Behavioral HealthHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 9, 2024

Drug testing covered in ASAM level 3.1 and 3.5 per diem bundles

Quality ManagementCommercialMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Behavioral HealthHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 4, 2024

Claims analysis of claims billed using the HL modifier

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

HEDIS Measure Tips — Adults’ Access to Preventive/Ambulatory Health Services (AAP) 2025

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

Products & Programs PharmacyMedicare AdvantageOctober 1, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

AdministrativeCommercialOctober 1, 2024

National Accounts 2025 precertification list