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

January 2025 Provider Newsletter

Featured Articles

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

AdministrativeMedicare AdvantageJanuary 1, 2025

D‑SNP members can earn rewards by participating in select healthcare activities

AdministrativeCommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information

Behavioral Health

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

Comprehensive, holistic care for obstructive sleep apnea

Policy Updates

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 19, 2024

Change to Prior Authorization Requirements

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesCommercialJanuary 1, 2025

Change to Prior Authorization Requirements

Medical Policies and Clinical Guidelines updates — December 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

Products & Programs

Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025

PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025

PharmacyCommercialDecember 27, 2024

Weight management program overview

PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

PharmacyMedicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

INBCBS-CDCRCM-074621-24

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).