March 1, 2025

March 2025 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageMarch 1, 2025

Reminder: provider data attestation

Medical Policy & Clinical GuidelinesMedicaid Managed CareFebruary 6, 2025

Clinical Criteria updates

Effective March 10, 2025

Administrative

AdministrativeMedicaid Managed CareMarch 1, 2025

Behind the scenes, get to know: Sheila Blackmore

AdministrativeMedicare AdvantageMedicaid Managed CareFebruary 25, 2025

Anthem will delegate care management to Carelon Health, Inc.

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

AdministrativeMedicaid Managed CareMarch 1, 2025

Achieve accurate reimbursements for behavioral health claims

AdministrativeCommercialMarch 1, 2025

New coding guidelines: include the anatomic modifier

AdministrativeMedicaid Managed CareOctober 1, 2024

Provider revalidations

Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Digital SolutionsCommercialFebruary 4, 2025

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & Training

Education & TrainingMedicaid Managed CareMarch 1, 2025

You are invited: doula orientation

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareJanuary 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

WebinarsMedicaid Managed CareMarch 1, 2025

You are invited: behavioral health orientation

WebinarsMedicaid Managed CareMarch 1, 2025

You are invited: general orientation

WebinarsMedicaid Managed CareJanuary 1, 2025

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

Policy Updates

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

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

MCG Care Guidelines 29th edition

Effective June 1, 2025

Medical Policy & Clinical GuidelinesMedicaid Managed CareFebruary 17, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Products & Programs

Federal Employee Program (FEP)CommercialMarch 1, 2025

Changes in Postal Service Health Benefits for 2025

PharmacyMedicaid Managed CareFebruary 24, 2025

Preapproval updates for medications billed under the medical benefit

Effective April 1, 2025
Amtagvi and Nexobrid

OHBCBS-CDCRCM-078142-25 , CPN78072