Highlights

Key Updates

AdministrativeMedicaidNovember 21, 2024

Medicaid contract expiring after December 31, 2024


What's New

Recent Updates

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidDecember 27, 2024

Enhance patient coordination with Total Member View

Products & Programs PharmacyCommercialDecember 27, 2024

Weight management program overview

Quality ManagementCommercialDecember 26, 2024

HEDIS Well Child and Immunizations Coding Bulletin 2025

Quality Management Optimizing HEDIS & STARSCommercialDecember 24, 2024

HEDIS CAT II Coding Bulletin 2025

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 19, 2024

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

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

AdministrativeCommercialDecember 3, 2024

Outpatient system updates for 2025

AdministrativeCommercialDecember 3, 2024

Professional system updates for 2025

Behavioral HealthCommercialMedicare AdvantageDecember 1, 2024

Comprehensive, holistic care for obstructive sleep apnea

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

AdministrativeCommercialDecember 1, 2024

Important information about utilization management

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

Products & Programs Federal Employee Program (FEP)CommercialDecember 1, 2024

FEP excited to join PSHB program in 2025

Products & Programs PharmacyCommercialDecember 1, 2024

Paragon Healthcare joins our medical specialty pharmacy provider network in 2025

Products & Programs PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

AdministrativeCommercialDecember 1, 2024

Coordination of care

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

AdministrativeCommercialDecember 1, 2024

Case Management program

Products & Programs PharmacyCommercialDecember 1, 2024

Pharmacy information available online

Quality Management Optimizing HEDIS & STARSMedicare AdvantageNovember 26, 2024

HEDIS Category II Coding Bulletin 2025

AdministrativeMedicaidNovember 21, 2024

Medicaid contract expiring after December 31, 2024

Policy UpdatesMedicaidNovember 21, 2024

Clinical Criteria update

Effective December 22, 2024

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 19, 2024

Roster Automation updates: roster download functionality

Products & Programs PharmacyCommercialNovember 18, 2024

Specialty pharmacy updates — December 2024

AdministrativeMedicare AdvantageNovember 18, 2024

Kentucky 2025 Medicare Advantage plan changes

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 12, 2024

Roster automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Quality ManagementMedicaidNovember 7, 2024

Provider: CAHPS awareness

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 7, 2024

Time to prepare for HEDIS medical record review

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 7, 2024

Time to prepare for HEDIS medical record review

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageMedicaidNovember 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Policy Updates Reimbursement PoliciesMedicaidNovember 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics

AdministrativeCommercialNovember 1, 2024

Personalized Match update

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 1, 2024

HEDIS medical record submission made easier with our Remote EMR Access service

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy reminder: Multiple Surgery — Facility

Products & Programs Federal Employee Program (FEP)CommercialNovember 1, 2024

Submit corrected claims electronically for the Federal Employee Program®