January 1, 2025

January 2025 Provider Newsletter

Featured Articles

AdministrativeCommercialJanuary 1, 2025

Drug fee schedule update

Digital SolutionsMedicaidDecember 24, 2024

Availity Essentials maternity update for providers

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 25, 2024

Time to prepare for HEDIS medical record review

Administrative

AdministrativeMedicare AdvantageJanuary 1, 2025

D‑SNP members can earn rewards by participating in select healthcare activities

AdministrativeCommercialMedicare AdvantageJanuary 1, 2025

New year, new labs: LabCorp and Quest Diagnostics now in‑network for Nevada plans

AdministrativeCommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information

Digital SolutionsCommercialMedicare AdvantageMedicaidDecember 30, 2024

Enhance patient coordination with Total Member View

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaidDecember 24, 2024

Prefix required on claim submissions

Policy Updates

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Policy UpdatesMedicare AdvantageNovember 27, 2024

Carelon Medical Benefits Management, Inc. updates

Effective March 23, 2025

Medical Policy & Clinical GuidelinesCommercialDecember 19, 2024

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

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

Medical Policy & Clinical GuidelinesCommercialDecember 18, 2024

Clinical UM Guidelines Notification

Prior AuthorizationMedicaidNovember 21, 2024

Prior authorization requirement changes

Effective January 1, 2025

Products & Programs

Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025

PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

PharmacyCommercialDecember 27, 2024

Weight management program overview

PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025

PharmacyMedicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

NVBCBS-CDCRCM-074633-24

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).