Highlights

Key Updates

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers


What's New

Recent Updates

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

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

Notice of material change/amendment to contract

New reimbursement policy: Code and Clinical Editing Guidelines — Professional and Facility

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

Notice of material change/amendment to contract

Reimbursement policy update: Bundled Services and Supplies — Professional

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

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

Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experience

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Enroll with Availity to verify your provider data

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

Notice of material change/amendment to contract

Precertification/Prior Authorization list change notification July 1, 2025

Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Notice of material change/amendment to contract

Medical Policy and Clinical Guideline updates

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Update: essential ICD‑10‑CM compliance for outpatient facility claims

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

Streamlining behavioral health authorizations via Availity Essentials

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — July 2025

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

Combat diabetes: Close the statin therapy gap for better heart health

Education & Training WebinarsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2025

Access our updated provider manual for July 1, 2025, changes

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

National Drug Codes (NDCs) are required for professional and outpatient claims

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 23, 2025

Essential information for providers: understanding Medicare Advantage group retiree plans

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 6, 2025

National Drug Codes (NDCs) are required for outpatient claims

Policy UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialJune 2, 2025

Notice of material change/amendment to contract

Specialty pharmacy updates: June 2025

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

LabCorp and Quest Diagnostics are in-network — reminder

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — June 2025

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

Unlock updated pharmacy insights today — visit our provider website

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

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

Notice of material change/amendment to contract

Clinical Criteria updates for specialty pharmacy

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Education & Training WebinarsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 1, 2025

Registration is now available for our upcoming CME webinar on Integrating Cancer Care

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

Bridging the gap: enhancing medication adherence for better health outcomes

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJune 1, 2025

Update to claims system for global surgical procedures for professional providers

Education & TrainingAMH Health, LLC | Medicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageMay 27, 2025

Boost your roster submission skills with Availity Essentials

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMay 22, 2025

Precertification/prior authorization requirement changes

Effective October 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Policy UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

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

Notice of material change/amendment to contract

Clinical Criteria updates for specialty pharmacy

Effective August 1, 2025

Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Notice of material change/amendment to contract

Medical Policy and Clinical Guideline updates

Effective August 1, 2025

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

Additional drug codes added to medical claims edit system

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — May 2025

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Free CE training: Lifestyle Medicine & Food as Medicine Essentials Course

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Wellness visits may increase appointment scheduling For members enrolled in an ACA plan

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 30, 2025

Notice of material change/amendment to contract

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

Effective August 1, 2025

Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageApril 18, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageApril 18, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 11, 2025

Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute Solutions