May 1, 2025

May 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid

Featured Articles


Administrative

AdministrativeMedicare AdvantageMedicaidMay 1, 2025

Additional drug codes added to medical claims edit system

AdministrativeMedicaidMay 1, 2025

CPT and HCPCS coding guidelines update

Education & Training

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Policy Updates

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 AdvantageMedicaidApril 30, 2025

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

Effective August 1, 2025

Medical Policy & Clinical GuidelinesCommercialMay 1, 2025

Medical Policy and Clinical Guideline updates

Effective August 1, 2025

Prior AuthorizationMedicaidApril 11, 2025

Prior authorization requirement changes

Effective June 1, 2025
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Products & Programs

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

PharmacyCommercialMay 1, 2025

Clinical Criteria updates for specialty pharmacy

Effective August 1, 2025


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