Highlights

Key Updates

Administrative Digital SolutionsMedicaidDecember 24, 2024

Availity Essentials maternity update for providers


What's New

Recent Updates

Products & Programs PharmacyCommercialDecember 27, 2024

Weight management program overview

Quality ManagementCommercialDecember 26, 2024

HEDIS Well Child and Immunizations Coding Bulletin 2025

Administrative Digital SolutionsMedicaidDecember 24, 2024

Availity Essentials maternity update for providers

Education & TrainingCommercialMedicare AdvantageMedicaidDecember 24, 2024

Prefix required on claim submissions

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 GuidelinesCommercialDecember 19, 2024

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

Policy Updates Medical Policy & Clinical GuidelinesCommercialDecember 18, 2024

Clinical UM Guidelines Notification

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

Policy Updates Reimbursement PoliciesCommercialDecember 1, 2024

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

AdministrativeCommercialDecember 1, 2024

Case Management program

AdministrativeMedicare AdvantageMedicaidDecember 1, 2024

Drug and biologic

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

Products & Programs PharmacyCommercialDecember 1, 2024

Pharmacy information available online

AdministrativeCommercialDecember 1, 2024

Coordination of care

Products & Programs PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

Products & Programs PharmacyCommercialDecember 1, 2024

Paragon Healthcare joins our medical specialty pharmacy provider network in 2025

Policy Updates Reimbursement PoliciesCommercialDecember 1, 2024

New reimbursement policy: Trauma Activation — Facility

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

FEP excited to join PSHB program in 2025

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

AdministrativeCommercialDecember 1, 2024

Important information about utilization management

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

AdministrativeCommercialMedicare AdvantageDecember 1, 2024

Quest Diagnostics joins our network on January 1

Policy UpdatesMedicare AdvantageNovember 27, 2024

Carelon Medical Benefits Management, Inc. updates

Effective March 23, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageNovember 26, 2024

HEDIS Category II Coding Bulletin 2025

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Policy Updates Prior AuthorizationMedicaidNovember 21, 2024

Prior authorization requirement changes

Effective January 1, 2025

AdministrativeMedicare AdvantageNovember 18, 2024

Nevada 2025 Medicare Advantage plan changes

Products & Programs PharmacyCommercialNovember 18, 2024

Specialty pharmacy updates — December 2024

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Policy UpdatesMedicaidNovember 15, 2024

Carelon Medical Benefits Management, Inc. updates

Effective December 18, 2024

Policy UpdatesMedicaidNovember 15, 2024

Clinical Criteria updates

Effective December 18, 2024

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 14, 2024

Maximizing care with regular provider data attestation

Administrative Digital SolutionsMedicaidNovember 14, 2024

Advancing digital efficiency by discontinuing paper remittances

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

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

Policy Updates Medical Policy & Clinical GuidelinesMedicaidNovember 14, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective December 15, 2024

Behavioral HealthMedicaidNovember 11, 2024

Nevada expanded applied behavioral analysis services to all ages

Policy UpdatesMedicaidNovember 7, 2024

Clinical Criteria update

Effective December 11, 2024

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Precertification List Change Notification — November 1, 2024