Key Updates
Medicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploads
CommercialMedicare AdvantageMedicaidAugust 25, 2025
Enhance your skills with expanded billing and coding training
Recent Updates
CommercialSeptember 18, 2025
Clinical UM Guidelines notificationCommercialSeptember 16, 2025
Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective January 10, 2026
CommercialSeptember 15, 2025
Streamlining your appeals process for inpatient and post‑acute facilitiesMedicaidSeptember 11, 2025
Precertification/prior authorization requirement changesEffective December 1, 2025
Medicare AdvantageSeptember 5, 2025
Anthem expands specialty pharmacy precertification listMedicaidSeptember 2, 2025
Carelon Medical Benefits Management, Inc. updatesEffective on October 5, 2025
CommercialSeptember 1, 2025
Specialty pharmacy updates — September 2025Medicare AdvantageSeptember 1, 2025
Medication safety: Reducing risks with thoughtful prescribing and monitoringMedicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploadsMedicaidSeptember 1, 2025
RSV immunization: key to infant healthMedicare AdvantageSeptember 1, 2025
Elevate your practice efficiency with electronic prescriber toolsCommercialAugust 26, 2025
New guidelines for PET radiotracer management in UM beginning December 1, 2025MedicaidAugust 26, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective November 15, 2025
CommercialAugust 26, 2025
Carelon Medical Benefits Management, Inc. Additional Outpatient Utilization Management and SurgicalMedicaidAugust 26, 2025
Carelon Medical Benefits Management, Inc. updatesCommercialMedicare AdvantageMedicaidAugust 25, 2025
Enhance your skills with expanded billing and coding trainingMedicare AdvantageAugust 25, 2025
Anthem expands specialty pharmacy precertification listsEffective December 1, 2025
Avtozma, Osenvelt, Ospomyv, Stoboclo, and Xbryk
Medicare AdvantageAugust 21, 2025
Medication safety: Clinical strategies for EMR monitoring and preventionMedicare AdvantageAugust 21, 2025
Carelon Medical Benefits Management, Inc. UpdatesEffective on September 25, 2025
CommercialAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective November 15, 2025
Medicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesMedicaidAugust 12, 2025
Carelon Medical Benefits Management, Inc. updatesMedicaidAugust 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective September 15, 2025
Medicare AdvantageAugust 1, 2025
Expanded specialty pharmacy precertification listEffective November 1, 2025
Bomyntra, Conexxence, Imaav, Jobevne, Omlyclo, Qfitlia, Vyalev, and Jobevne
CommercialAugust 1, 2025
Support your patients with the CarelonRx, Inc. and Lark Weight Management ProgramCommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideCommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patientsCommercialAugust 1, 2025
Upcoming updates: medical claims edit system for self‑administered drugsCommercialMedicaidAugust 1, 2025
Dispute resolution process for care providersCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthMedicaidAugust 1, 2025
Upcoming changes to outpatient facility claims processingCommercialAugust 1, 2025
Facility diagnostic radiopharmaceuticals and contrast mediaCommercialMedicare AdvantageMedicaidAugust 1, 2025
You are invited: immunization measures webinarCommercialAugust 1, 2025
SUD confidentiality protections for membersMedicare AdvantageJuly 31, 2025
Carelon Medical Benefits Management, Inc. updatesEffective September 1, 2025
MedicaidJuly 29, 2025
Prior authorization requirement updated for procedure code H0038Medicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025Medicare AdvantageJuly 23, 2025
Carelon Medical Benefits Management, Inc. updatesEffective on October 1, 2025
CommercialMedicare AdvantageMedicaidJuly 23, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 22, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideCommercialMedicare AdvantageMedicaidJuly 18, 2025
New mandatory fields in roster templateMedicaidJuly 10, 2025
Quarterly pharmacy formulary change notice