Highlights

Key Updates

Administrative Digital SolutionsCommercialMedicare AdvantageNovember 1, 2024

Roster Automation updates: roster download functionality

Quality ManagementCommercialMedicare AdvantageMedicaid Managed CareOctober 25, 2024

Time to prepare for HEDIS medical record review

AdministrativeMedicaid Managed CareOctober 23, 2024

Provider data accuracy

Education & TrainingMedicaid Managed CareOctober 23, 2024

Reminder: take action to protect infants from respiratory syncytial virus this season

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder


What's New

Recent Updates

Policy Updates Medical Policy & Clinical GuidelinesMedicaid Managed CareNovember 21, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 1, 2025

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

AdministrativeMedicare AdvantageNovember 18, 2024

Ohio 2025 Medicare Advantage plan changes

Products & Programs PharmacyCommercialNovember 18, 2024

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Specialty pharmacy updates — December 2024

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Policy Updates Prior AuthorizationMedicaid Managed CareNovember 12, 2024

Prior authorization requirement changes

Effective January 1, 2025

Policy Updates Prior AuthorizationMedicaid Managed CareNovember 8, 2024

Program date change announcement

Administrative Digital SolutionsCommercialMedicare AdvantageNovember 1, 2024

Roster Automation updates: roster download functionality

AdministrativeCommercialNovember 1, 2024

Personalized Match update

Education & TrainingMedicaid Managed CareNovember 1, 2024

You are invited: Provider orientation

Education & TrainingMedicaid Managed CareNovember 1, 2024

You are invited: Hospice education webinar

Education & TrainingMedicaid Managed CareNovember 1, 2024

You are invited: Behavioral health provider orientation

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics

Products & Programs Federal Employee Program (FEP)CommercialNovember 1, 2024

Submit corrected claims electronically for the Federal Employee Program®

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy reminder: Multiple Surgery — Facility

AdministrativeMedicaid Managed CareNovember 1, 2024

Behind the scenes, get to know: Patrick Stone

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Behavioral HealthCommercialNovember 1, 2024

Introducing a new Applied Behavior Analysis Provider Resource Guide

Administrative Digital SolutionsMedicaid Managed CareNovember 1, 2024

Enhanced personalized match: making the care provider search more informed and personalized

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Quality ManagementMedicare AdvantageMedicaid Managed CareOctober 29, 2024

HEDIS Measure Tips — Appropriate Treatment for Upper Respiratory Infection (URI) 2025

Quality ManagementCommercialMedicare AdvantageMedicaid Managed CareOctober 25, 2024

Time to prepare for HEDIS medical record review

Products & Programs PharmacyCommercialOctober 24, 2024

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Specialty pharmacy updates — November 2024

Quality ManagementMedicaid Managed CareOctober 24, 2024

Provider: CAHPS awareness

AdministrativeMedicaid Managed CareOctober 23, 2024

Provider data accuracy

Education & TrainingMedicaid Managed CareOctober 23, 2024

Reminder: take action to protect infants from respiratory syncytial virus this season

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 23, 2024

HEDIS Measure Tips — Appropriate Testing for Pharyngitis (CWP) 2025

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Policy Updates Medical Policy & Clinical GuidelinesMedicaid Managed CareOctober 22, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective December 1, 2024

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 22, 2024

HEDIS Measure Tips — Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) 2025

Administrative Digital SolutionsCommercialOctober 21, 2024

Notification of authorization fax number changes

AdministrativeMedicaid Managed CareOctober 15, 2024

Updated guidance for Immunizations Covered by Vaccines for Children

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder

Policy Updates Prior AuthorizationMedicaid Managed CareOctober 10, 2024

Prior authorization requirement changes

Effective December 1, 2024

Policy Updates Prior AuthorizationMedicaid Managed CareOctober 9, 2024

Prior authorization requirement changes

Effective December 1, 2024

Quality ManagementCommercialMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

HEDIS Measure Tips — Adults’ Access to Preventive/Ambulatory Health Services (AAP) 2025

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

Administrative Digital SolutionsMedicare AdvantageOctober 1, 2024

Introducing the Care Provider Recognition Program from Anthem