Key Updates
CommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar series
Recent Updates
CommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)CommercialFebruary 1, 2025
Medical records needed for accurate payment of certain facility inpatient claimsCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialMedicare AdvantageFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®Medicare AdvantageJanuary 28, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025CommercialJanuary 22, 2025
Breast Cancer Screening (BCS-E) 2025CommercialJanuary 22, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025CommercialJanuary 21, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 21, 2025
Controlling High Blood Pressure (CBP)CommercialJanuary 17, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 16, 2025
Asthma Medication Ratio (AMR) 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 16, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 14, 2025
Authorization for post‑acute care services for FEP membersMedicare AdvantageJanuary 13, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025Medicare AdvantageJanuary 13, 2025
Colorectal Cancer Screening (COL‑E) 2025Medicare AdvantageJanuary 13, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 13, 2025
Medication Adherence 2025Medicare AdvantageJanuary 12, 2025
Medication Adherence 2025Medicare AdvantageJanuary 9, 2025
Advanced Illness and Frailty 2025Medicare AdvantageJanuary 9, 2025
Transition of Care (TRC) 2025Medicare AdvantageJanuary 8, 2025
Breast Cancer Screening (BCS-E) 2025Medicare AdvantageJanuary 7, 2025
Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025Medicare AdvantageJanuary 6, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 6, 2025
HEDIS Desktop Reference Guide for Commercial 2025CommercialMedicare AdvantageJanuary 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingMedicare AdvantageJanuary 1, 2025
Kroger Specialty Pharmacy acquisitionCommercialJanuary 1, 2025
Introducing Coupe Health — quality care with clear pricing and no upfront paymentsCommercialJanuary 1, 2025
CAA: Providers required to verify online provider directory informationCommercialMedicare AdvantageMedicaidJanuary 1, 2025
Roster Automation updates effective November 15, 2024: use Error Report to correct roster errorsMedicare AdvantageJanuary 1, 2025
Announcing Health Perks — earn rewards for your healthcare activitiesCommercialJanuary 1, 2025
Medical Policies and Clinical Guidelines updates — December 2024CommercialJanuary 1, 2025
2025 FEHB and PSHB information available onlineMedicare AdvantageDecember 31, 2024
Important information about specialty prescriptionsCommercialMedicare AdvantageMedicaidDecember 27, 2024
Enhance patient coordination with Total Member ViewCommercialDecember 27, 2024
Weight management program overviewCommercialDecember 26, 2024
HEDIS Well Child and Immunizations Coding Bulletin 2025CommercialDecember 24, 2024
HEDIS® Category II Coding Bulletin 2025Medicare AdvantageDecember 23, 2024
Specialty pharmacy precertification list expansionEffective March 1, 2025
Medicare AdvantageDecember 23, 2024
Specialty Pharmacy Precertification and Step Therapy list expansionEffective April 1, 2025
CommercialMedicare AdvantageDecember 19, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesMedicare AdvantageDecember 16, 2024
Shortage of repackaged bevacizumab for ophthalmic useMedicare AdvantageDecember 4, 2024
Medical Policies and Clinical Utilization Management Guidelines updateEffective January 5, 2024
CommercialDecember 3, 2024
Outpatient system updates for 2025