Highlights

Key Updates

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series


What's New

Recent Updates

Policy UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Developmental screening in the first three years of life

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Chlamydia Screening (CHL) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 10, 2025

Colorectal Cancer Screening (COL-E) 2025

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialFebruary 4, 2025

Expansion of Carelon Medical Benefits Management, Inc. programs

Products & Programs Federal Employee Program (FEP)Anthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Corrected claim guidance for the Federal Employee Program®

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 1, 2025

New Communication Center added to Availity Essentials

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Notice of material change/amendment to contract

Clinical Criteria updates for specialty pharmacy

Effective May 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Notice of material change/amendment to contract

Medical records needed for accurate payment of certain facility inpatient claims

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Pharmacy information available on our provider website

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

AdministrativeAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — February 2025

Policy Updates Reimbursement PoliciesAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Notice of material change/amendment to contract

Reimbursement policy update: Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and Facility

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialJanuary 27, 2025

Key formulary updates: effective January 1, 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 22, 2025

Breast Cancer Screening (BCS-E) 2025

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialJanuary 22, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 21, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 21, 2025

Controlling High Blood Pressure (CBP)

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialJanuary 17, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 16, 2025

Asthma Medication Ratio (AMR) 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJanuary 16, 2025

Submitting authorization for NICU services facilitates accurate and timely claims processing

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 16, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Products & Programs Federal Employee Program (FEP)Anthem Blue Cross and Blue Shield | CommercialJanuary 14, 2025

Authorization for post‑acute care services for FEP members

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 13, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 13, 2025

Colorectal Cancer Screening (COL‑E) 2025

Quality ManagementAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 13, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 13, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 12, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 9, 2025

Advanced Illness and Frailty 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 9, 2025

Transition of Care (TRC) 2025

Quality ManagementAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 8, 2025

Breast Cancer Screening (BCS-E) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 7, 2025

Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 6, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 6, 2025

HEDIS Desktop Reference Guide for Commercial 2025

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 1, 2025

Specialty pharmacy precertification list expansion

Effective March 1, 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 1, 2025

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 1, 2025

Important information about specialty prescriptions

Policy Updates Reimbursement PoliciesAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

Notice of material change/amendment to contract

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services — Professional

Products & ProgramsAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

Introducing Coupe Health — quality care with clear pricing and no upfront payments

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — January 2025

Products & Programs Federal Employee Program (FEP)Anthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJanuary 1, 2025

Shortage of repackaged bevacizumab for ophthalmic use

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageDecember 30, 2024

Enhance patient coordination with Total Member View