May 1, 2025

May 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid

Featured Articles

Education & TrainingCommercialMedicare AdvantageMedicaidMay 1, 2025

Welcome to West Henderson Hospital


Administrative

AdministrativeMedicare AdvantageMedicaidMay 1, 2025

Additional drug codes added to medical claims edit system

Education & Training

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Policy Updates

Policy UpdatesMedicare AdvantageApril 1, 2025

Carelon Medical Benefits Management, Inc. updates

Effective May 2, 2025

Policy UpdatesMedicare AdvantageApril 1, 2025

Carelon Medical Benefits Management, Inc. updates

Effective May 3, 2025

Policy UpdatesMedicaidApril 9, 2025

Carelon Medical Benefits Management, Inc. updates

Effective May 10, 2025

Policy UpdatesMedicare AdvantageApril 1, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 15, 2025

Policy UpdatesMedicaidApril 3, 2025

Clinical Criteria updates

Effective May 7, 2025

Medical Policy & Clinical GuidelinesMedicaidApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 1, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageApril 30, 2025

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

Effective August 1, 2025

Prior AuthorizationMedicaidApril 4, 2025

Prior authorization requirement changes

Effective June 1, 2025

Products & Programs

PharmacyMedicaidApril 29, 2025

New preapproval requirements for Givlaari

Effective June 1, 2025

PharmacyMedicaidApril 29, 2025

New preapproval rules for medications

Effective June 1, 2025
Ebglyss, Lymphir, Niktimvo, and Ocrevus Zunovo

PharmacyMedicare AdvantageApril 18, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

PharmacyMedicare AdvantageApril 18, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost


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