January 1, 2025

January 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid Managed Care

Featured Articles

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Digital SolutionsMedicaid Managed CareDecember 24, 2024

Availity Essentials maternity update for providers

Quality ManagementCommercialMedicare AdvantageMedicaid Managed CareOctober 25, 2024

Time to prepare for HEDIS medical record review

Administrative

AdministrativeMedicare AdvantageJanuary 1, 2025

D‑SNP members can earn rewards by participating in select healthcare activities

AdministrativeMedicaid Managed CareJanuary 1, 2025

Updates to correct coding editing

AdministrativeCommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information

Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareDecember 30, 2024

Enhance patient coordination with Total Member View

Behavioral Health

Behavioral HealthMedicaid Managed CareJanuary 1, 2025

Guidance for mental health and addiction services providers

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Hospice webinar

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Nursing facility webinar

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Behavioral health provider orientation

Education & TrainingMedicaid Managed CareJanuary 1, 2025

You are invited: Medicaid provider orientation

WebinarsMedicaid Managed CareJanuary 1, 2025

You are invited: Review the Value-Added Benefits and Social Determinants of Health program

WebinarsMedicaid Managed CareDecember 1, 2024

You are invited: doula orientation

Policy Updates

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Medical Policy & Clinical GuidelinesCommercialJanuary 1, 2025

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

Medical Policies and Clinical Guidelines updates — December 2024

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 19, 2024

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

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

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

Products & Programs

Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025

PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

PharmacyCommercialDecember 27, 2024

Weight management program overview

PharmacyMedicaid Managed CareDecember 20, 2024

Prior authorization updates for medications billed under the medical benefit

Effective February 1, 2025
Alyglo, Simlandi, and Winrevair

PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025

PharmacyMedicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

OHBCBS-CDCRCM-074636-24

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