Highlights

Key Updates

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 19, 2025

Technical difficulties: My Diverse Patients

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency


What's New

Recent Updates

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 19, 2025

Technical difficulties: My Diverse Patients

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 14, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 14, 2025

Controlling High Blood Pressure (CBP) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 11, 2025

Care for Older Adults (COA) 2025

Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 1, 2025

Reminder: provider data attestation

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — March 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Certain modifiers for outpatient claims will receive prepayment coding review

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Update: Drug claims edits to focus on FDA‑approved indications

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Notice of material change/amendment to contract

Precertification list change notification March 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

New coding guidelines: include the anatomic modifier

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

Changes in Postal Service Health Benefits for 2025

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

Clarification to reimbursement policy: Incident to Services and Billing Professional

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

New reimbursement policy: Place of Service — Professional

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 1, 2025

Electronic payments and Explanation of Payment starting in June

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMarch 1, 2025

Electronic payments starting in June 2025

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageFebruary 28, 2025

Resources to support diverse patients and communities

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency

Policy UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageFebruary 21, 2025

Advanced Illness and Frailty Exclusions 2025

Education & Training WebinarsAnthem Blue Cross and Blue Shield | CommercialFebruary 21, 2025

Start 2025 with an easy way to earn continuing education credits

Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

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

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

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

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

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

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

2025 Clinical Quality in Practice webinar series

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

Pharmacy information available on our provider website

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

Notice of material change/amendment to contract

Clinical Criteria updates for specialty pharmacy

Effective May 1, 2025

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

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