Key Updates
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
Medicare 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 AdvantageApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingCommercialApril 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 PatientsHoosier 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
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
Hoosier 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 EssentialsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
New federal rule transforms confidentiality protocols for SUD patient recordsCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2025
Reminder: provider data attestationMedicare 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 efficiency