Highlights

Key Updates

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

Reminder: provider data attestation


What's New

Recent Updates

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

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

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

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

Streamline your prior authorizations with our digital tools

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

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

Additional drug codes added to medical claims edit system

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

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

AdministrativeAnthem Blue Cross and Blue Shield | CommercialApril 1, 2025

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — April 2025

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

Notice of material change/amendment to contract

Specialty pharmacy updates — April 2025

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

Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialMarch 28, 2025

Streamline your workflow: Submit BH authorizations through Availity Essentials

Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

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

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 August

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 August 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

Update: 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

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 ManagementAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Developmental screening in the first three years of life

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®

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

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

New Communication Center added to Availity Essentials