Key Updates
CommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar series
Recent Updates
CommercialFebruary 18, 2025
MCG Care Guidelines 29th editionMedicaidFebruary 17, 2025
MCG Care Guidelines 29th editionCommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025CommercialFebruary 10, 2025
Colorectal Cancer Screening (COL-E) 2025MedicaidFebruary 4, 2025
You are invited: provider coding educationCommercialFebruary 4, 2025
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialMedicare AdvantageMedicaidFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialFebruary 1, 2025
Clinical Criteria updates for specialty pharmacyCommercialFebruary 1, 2025
Medical Policy and Clinical Guideline updatesCommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Medical records needed for accurate payment of certain facility inpatient claimsCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)MedicaidJanuary 31, 2025
Reconciliation due to All Patient Refined Diagnosis Related Groups (APR-DRGs) UpdateCommercialJanuary 30, 2025
PT and OT fee increase for Commercial productsMedicare AdvantageJanuary 28, 2025
Eye Exam for Patients with Diabetes (EED) 2025MedicaidJanuary 28, 2025
Quarterly pharmacy formulary change noticeCommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025MedicaidJanuary 27, 2025
Environmental screening and toxins to avoid during pregnancyCommercialJanuary 22, 2025
Breast Cancer Screening (BCS-E) 2025CommercialJanuary 22, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025CommercialJanuary 21, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 21, 2025
Controlling High Blood Pressure (CBP)CommercialJanuary 17, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 16, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 16, 2025
Asthma Medication Ratio (AMR) 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 14, 2025
Authorization for post‑acute care services for FEP membersMedicare AdvantageJanuary 13, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025MedicaidJanuary 13, 2025
Integrating Fluoride Varnish into Well-Child Visits for Young ChildrenMedicare AdvantageJanuary 13, 2025
Colorectal Cancer Screening (COL‑E) 2025Medicare AdvantageJanuary 13, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 13, 2025
Medication Adherence 2025Medicare AdvantageJanuary 12, 2025
Medication Adherence 2025Medicare AdvantageJanuary 9, 2025
Transition of Care (TRC) 2025Medicare AdvantageJanuary 9, 2025
Advanced Illness and Frailty 2025Medicare AdvantageJanuary 8, 2025
Breast Cancer Screening (BCS-E) 2025Medicare AdvantageJanuary 7, 2025
Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025MedicaidJanuary 6, 2025
Behavioral health and substance use measures with telehealth accommodationsMedicaidJanuary 6, 2025
Prior authorization updates for medications billed under the medical benefitEffective March 1, 2025
Kisunla and Piasky
CommercialJanuary 6, 2025
HEDIS Desktop Reference Guide for Commercial 2025Medicare AdvantageJanuary 6, 2025
Adult Immunization Status (AIS‑E) 2025CommercialMedicare AdvantageMedicaidJanuary 1, 2025
Enhance billing and coding accuracy with new Payment Integrity training