Key Updates
CommercialJune 1, 2025
Availity Essentials Provider Overpayments application launch
Medicare AdvantageJune 1, 2025
Medicare preferred continuous glucose monitors
CommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminder
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 21, 2025
Updated Clinical Practice Guidelines now available
CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
Reminder: provider data attestation
Recent Updates
CommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderMedicare AdvantageJune 1, 2025
Medicare preferred continuous glucose monitorsCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launchHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJune 1, 2025
Clarifying roles in healthcare: member rights and responsibilitiesMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialMedicare AdvantageJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJune 1, 2025
Submitting BH authorizations in Availity EssentialsMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialJune 1, 2025
Update to claims system for global surgical proceduresMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJune 1, 2025
Additional drug codes added to medical claims edit systemHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJune 1, 2025
Provider Pathways: your personalized learning platformCommercialMay 30, 2025
Key updates to the Designated Medical Specialty Pharmacy Drug ListMedicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMay 22, 2025
Action required: annual patient safety attestationMedicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 22, 2025
You are invited: Indiana PathWays for Aging trainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 21, 2025
Updated Clinical Practice Guidelines now availableHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 20, 2025
New preapproval requirements for GivlaariEffective August 1, 2025
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 14, 2025
Announcement: Temporary Emergency Financial Assistance Payment ReconciliationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 1, 2025
Streamlined calls: validate with NPI or TINCommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 1, 2025
FDA lifts risk evaluation and mitigation strategy reporting requirements for ClozapineCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsCommercialMay 1, 2025
Upcoming changes to the provider manual effective August 2025CommercialMedicare AdvantageApril 30, 2025
Change to Prior Authorization Requirements
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective August 1, 2025
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 29, 2025
Prior authorization requirement changesEffective July 1, 2025
CPT Codes: E0468, E0482, and E0617
Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 29, 2025
Contractual obligations for care coordination and case management engagementMedicare 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
Medicare 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 CentralHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 2, 2025
Precertification/prior authorization requirement changesEffective June 1, 2025
CommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingCommercialMedicare 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 — ProfessionalCommercialMarch 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 Patients