Key Updates
MedicaidNovember 21, 2024
Medicaid contract expiring after December 31, 2024
Recent Updates
CommercialMedicare 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 CAT II Coding Bulletin 2025Medicare AdvantageAMH - Medicare AdvantageDecember 23, 2024
Specialty pharmacy precertification list expansionMedicare AdvantageAMH - Medicare AdvantageDecember 23, 2024
Specialty Pharmacy Precertification and Step Therapy list expansionCommercialMedicare AdvantageDecember 19, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesMedicare AdvantageAMH - Medicare 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 2025CommercialDecember 3, 2024
Professional system updates for 2025CommercialMedicare AdvantageDecember 1, 2024
Comprehensive, holistic care for obstructive sleep apneaCommercialDecember 1, 2024
Members’ Rights and ResponsibilitiesCommercialDecember 1, 2024
Important information about utilization managementCommercialDecember 1, 2024
Clinical practice and preventive health guidelines available onlineCommercialDecember 1, 2024
FEP excited to join PSHB program in 2025CommercialDecember 1, 2024
Paragon Healthcare joins our medical specialty pharmacy provider network in 2025CommercialDecember 1, 2024
Kroger Specialty Pharmacy acquisitionCommercialDecember 1, 2024
Coordination of careCommercialDecember 1, 2024
PCP after‑hours access requirementsCommercialDecember 1, 2024
Case Management programCommercialDecember 1, 2024
Pharmacy information available onlineMedicare AdvantageNovember 26, 2024
HEDIS Category II Coding Bulletin 2025CommercialNovember 25, 2024
Submitting authorization for NICU services facilitates accurate and timely claims processingMedicaidNovember 22, 2024
Reminder: take action to protect infants from respiratory syncytial virus this seasonMedicaidNovember 21, 2024
Medicaid contract expiring after December 31, 2024CommercialNovember 21, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialMedicare AdvantageMedicaidNovember 19, 2024
Roster Automation updates: roster download functionalityCommercialNovember 18, 2024
Specialty pharmacy updates — December 2024Medicare AdvantageNovember 18, 2024
Kentucky 2025 Medicare Advantage plan changesMedicare AdvantageNovember 18, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsMedicare AdvantageNovember 18, 2024
Notice of change: Part D Rx HCCsMedicare AdvantageNovember 15, 2024
Skilled nursing facility — vaccine serum compensationMedicare AdvantageNovember 14, 2024
Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?CommercialMedicare AdvantageMedicaidNovember 12, 2024
Roster automation updates effective November 15, 2024: enhanced reporting to increase data accuracyMedicaidNovember 7, 2024
Provider: CAHPS awarenessCommercialMedicare AdvantageMedicaidNovember 7, 2024
Time to prepare for HEDIS medical record reviewCommercialMedicare AdvantageMedicaidNovember 7, 2024
Time to prepare for HEDIS medical record reviewCommercialMedicare AdvantageMedicaidNovember 1, 2024
Prevent flu and COVID-19: drive the change through vaccinationCommercialNovember 1, 2024
More error types for corrected claims submitted through EDI now availableCommercialNovember 1, 2024
Adopting digital member ID cardsMedicaidNovember 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant ServicesCommercialNovember 1, 2024
New claims requirement: add-on codes must include primary procedure starting December 2024Medicare AdvantageNovember 1, 2024
Improving patient outcomes: back to the basicsCommercialNovember 1, 2024
Personalized Match updateCommercialMedicare AdvantageMedicaidNovember 1, 2024
HEDIS medical record submission made easier with our Remote EMR Access serviceCommercialNovember 1, 2024
Reimbursement policy reminder: Multiple Surgery — FacilityCommercialNovember 1, 2024
Submit corrected claims electronically for the Federal Employee Program®