Key Updates
MedicaidDecember 24, 2024
Availity Essentials maternity update for providers
Recent Updates
CommercialDecember 27, 2024
Weight management program overviewCommercialDecember 26, 2024
HEDIS Well Child and Immunizations Coding Bulletin 2025MedicaidDecember 24, 2024
Availity Essentials maternity update for providersCommercialMedicare AdvantageMedicaidDecember 24, 2024
Prefix required on claim submissionsCommercialDecember 24, 2024
HEDIS CAT II Coding Bulletin 2025Medicare AdvantageAMH - Medicare AdvantageDecember 23, 2024
Specialty pharmacy precertification list expansionMedicare AdvantageAMH - Medicare AdvantageDecember 23, 2024
Specialty Pharmacy Precertification and Step Therapy list expansionCommercialDecember 19, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesCommercialDecember 18, 2024
Clinical UM Guidelines NotificationMedicare AdvantageAMH - Medicare AdvantageDecember 16, 2024
Shortage of repackaged bevacizumab for ophthalmic useMedicare AdvantageDecember 4, 2024
Medical Policies and Clinical Utilization Management Guidelines updateEffective January 5, 2024
CommercialDecember 3, 2024
Outpatient system updates for 2025CommercialDecember 3, 2024
Professional system updates for 2025CommercialDecember 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant Services — ProfessionalCommercialDecember 1, 2024
Case Management programMedicare AdvantageMedicaidDecember 1, 2024
Drug and biologicCommercialDecember 1, 2024
PCP after‑hours access requirementsCommercialDecember 1, 2024
Pharmacy information available onlineCommercialDecember 1, 2024
Coordination of careCommercialDecember 1, 2024
Kroger Specialty Pharmacy acquisitionCommercialDecember 1, 2024
Paragon Healthcare joins our medical specialty pharmacy provider network in 2025CommercialDecember 1, 2024
New reimbursement policy: Trauma Activation — FacilityCommercialDecember 1, 2024
FEP excited to join PSHB program in 2025CommercialDecember 1, 2024
Clinical practice and preventive health guidelines available onlineCommercialDecember 1, 2024
Important information about utilization managementCommercialDecember 1, 2024
Members’ Rights and ResponsibilitiesCommercialMedicare AdvantageDecember 1, 2024
Quest Diagnostics joins our network on January 1Medicare AdvantageNovember 27, 2024
Carelon Medical Benefits Management, Inc. updatesEffective March 23, 2025
Medicare AdvantageNovember 26, 2024
HEDIS Category II Coding Bulletin 2025CommercialNovember 25, 2024
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialNovember 21, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsMedicare AdvantageNovember 18, 2024
Nevada 2025 Medicare Advantage plan changesCommercialNovember 18, 2024
Specialty pharmacy updates — December 2024Medicare AdvantageNovember 18, 2024
Notice of change: Part D Rx HCCsMedicare AdvantageNovember 15, 2024
Skilled nursing facility — vaccine serum compensationMedicaidNovember 15, 2024
Carelon Medical Benefits Management, Inc. updatesEffective December 18, 2024
CommercialMedicare AdvantageMedicaidNovember 14, 2024
Maximizing care with regular provider data attestationMedicaidNovember 14, 2024
Advancing digital efficiency by discontinuing paper remittancesMedicare AdvantageNovember 14, 2024
Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?MedicaidNovember 14, 2024
Medical Policies and Clinical Utilization Management Guidelines updateEffective December 15, 2024
MedicaidNovember 11, 2024
Nevada expanded applied behavioral analysis services to all agesCommercialMedicare AdvantageMedicaidNovember 1, 2024
Roster Automation updates: roster download functionalityCommercialNovember 1, 2024
High Performing and Blue National Designated Providers may also be known as Anthem Diamond ProvidersCommercialNovember 1, 2024
New claims requirement: add-on codes must include primary procedure starting December 2024CommercialNovember 1, 2024
Adopting digital member ID cardsCommercialNovember 1, 2024
Precertification List Change Notification — November 1, 2024