CommercialMedicare AdvantageMedicaidMarch 1, 2025

March 2025 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageMedicaidMarch 1, 2025

Reminder: provider data attestation

Administrative

AdministrativeMedicaidMarch 1, 2025

Reminder of operational enhancements to MLTC program

AdministrativeCommercialMarch 1, 2025

Certain modifiers for outpatient claims will receive prepayment coding review

AdministrativeCommercialMarch 1, 2025

Update: Drug claims edits to focus on FDA‑approved indications

AdministrativeCommercialMarch 1, 2025

New coding guidelines: include the anatomic modifier

AdministrativeMedicaidJanuary 31, 2025

Reconciliation due to All Patient Refined Diagnosis Related Groups (APR-DRGs) Update

Digital SolutionsCommercialFebruary 4, 2025

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & Training

Education & TrainingMedicaidMarch 1, 2025

Improving patient outcomes: introducing the home blood pressure monitoring initiative

Education & TrainingCommercialMedicare AdvantageMedicaidJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

WebinarsCommercialFebruary 21, 2025

Start 2025 with an easy way to earn continuing education credits

Policy Updates

Policy UpdatesMedicaidJanuary 31, 2025

Clinical Criteria updates

Effective March 7, 2025

Policy UpdatesMedicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Medical Policy & Clinical GuidelinesCommercialFebruary 18, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Medical Policy & Clinical GuidelinesMedicaidFebruary 17, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Prior AuthorizationCommercialMarch 1, 2025

Precertification list change notification March 1, 2025

Products & Programs

Federal Employee Program (FEP)CommercialMarch 1, 2025

Changes in Postal Service Health Benefits for 2025

PharmacyMedicaidFebruary 19, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Anktiva, Hercessi, and Imdelltra

PharmacyMedicaidFebruary 24, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Esperoct

PharmacyMedicaidFebruary 24, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Tevimbra and Tyenne

PharmacyMedicaidFebruary 25, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Orencia and Avsola

NYBCBS-CDCRCM-078140-25 , CPN78072