Key Updates
CommercialMedicare AdvantageMedicaidNovember 14, 2024
Maximizing care with regular provider data attestation
CommercialMedicare AdvantageMedicaidNovember 1, 2024
Roster Automation updates: roster download functionality
CommercialMedicare AdvantageMedicaidOctober 25, 2024
Time to prepare for HEDIS medical record review
CommercialOctober 23, 2024
Do you offer telehealth services? Let us know!
Medicare AdvantageOctober 15, 2024
Model of Care training reminder
Recent Updates
CommercialNovember 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 changesMedicare 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
Material adverse change
Precertification List Change Notification — November 1, 2024Codes J3393 and J3394
CommercialNovember 1, 2024
Personalized Match updateMedicare AdvantageNovember 1, 2024
Improving patient outcomes: back to the basicsCommercialNovember 1, 2024
More error types for corrected claims submitted through EDI now availableCommercialNovember 1, 2024
Material adverse change
Precertification List Change Notification — November 1, 2024CommercialNovember 1, 2024
New claims requirement: add-on codes must include primary procedure starting December 2024CommercialNovember 1, 2024
Adopting digital member ID cardsCommercialNovember 1, 2024
High Performing and Blue National Designated Providers may also be known as Anthem Diamond ProvidersMedicaidNovember 1, 2024
Enhanced personalized match: making the care provider search more informed and personalizedCommercialNovember 1, 2024
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicaidOctober 29, 2024
1115 Institution for Mental Disease substance use disorder demonstration waiverMedicare AdvantageMedicaidOctober 29, 2024
HEDIS Measure Tips — Appropriate Treatment for Upper Respiratory Infection (URI) 2025CommercialMedicare AdvantageMedicaidOctober 25, 2024
Time to prepare for HEDIS medical record reviewMedicaidOctober 24, 2024
Clarification to Carelon Medical Benefits Management, Inc. updates effective September 1, 2024MedicaidOctober 24, 2024
Provider: CAHPS awarenessMedicaidOctober 23, 2024
Reminder: take action to protect infants from respiratory syncytial virus this seasonCommercialMedicare AdvantageOctober 23, 2024
HEDIS Measure Tips — Appropriate Testing for Pharyngitis (CWP) 2025CommercialOctober 23, 2024
Do you offer telehealth services? Let us know!CommercialMedicare AdvantageOctober 22, 2024
HEDIS Measure Tips — Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) 2025Medicare AdvantageOctober 16, 2024
Clarification to Carelon Medical Benefits Management, Inc. updates effective September 1, 2024Medicare AdvantageOctober 15, 2024
Model of Care training reminderMedicaidOctober 11, 2024
Billing guidelines for outpatient observation: 48-hour ruleMedicaidOctober 8, 2024
Prior authorization updates for medications billed under the medical benefitEffective December 1, 2024
Amtagvi, iDoseTR, and Nexobrid
MedicaidOctober 8, 2024
PCP changes now available in Availity EssentialsCommercialMedicare AdvantageOctober 7, 2024
HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025MedicaidOctober 4, 2024
Prior authorization updates for medications billed under the medical benefitEffective December 1, 2024
Alyglo, Simlandi, and Winrevair
Medicare AdvantageOctober 4, 2024
HEDIS Measure Tips — Adults’ Access to Preventive/Ambulatory Health Services (AAP) 2025CommercialMedicare AdvantageOctober 3, 2024
Blood Pressure Control for Patients With Diabetes (BPD) 2025Medicare AdvantageOctober 2, 2024
Pharmacotherapy Management of COPD Exacerbation (PCE) 2025