May 1, 2025

May 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid Managed Care

Featured Articles

Administrative

AdministrativeCommercialMay 1, 2025

Unlock the power of electronic claims with Availity Essentials

AdministrativeMedicare AdvantageMedicaid Managed CareMay 1, 2025

Additional drug codes added to medical claims edit system

Education & Training

Education & TrainingCommercialMay 1, 2025

Free CE training: Lifestyle Medicine & Food as Medicine Essentials Course

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Education & TrainingMedicaid Managed CareMay 1, 2025

You are invited: doula orientation

Education & TrainingMedicaid Managed CareApril 1, 2025

You are invited: Provider Advisory Council meeting

Policy Updates

Policy UpdatesMedicaid Managed CareApril 22, 2025

Carelon Medical Benefits Management, Inc. updates

Effective May 23, 2025

Policy UpdatesMedicaid Managed CareApril 3, 2025

Clinical Criteria updates

Effective May 7, 2025

Medical Policy & Clinical GuidelinesCommercialApril 10, 2025

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

Medical Policies and Clinical Guidelines updates, May 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageApril 30, 2025

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

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

Effective August 1, 2025

Prior AuthorizationMedicaid Managed CareApril 1, 2025

Precertification/prior authorization requirement changes

Effective June 1, 2025

Products & Programs

PharmacyMedicaid Managed CareApril 15, 2025

Prior authorization updates for medications billed under the medical benefit

Effective June 1, 2025
Anktiva, Hercessi and Imdelltra

PharmacyMedicaid Managed CareApril 29, 2025

New preapproval requirements for Givlaari

Effective June 1, 2025

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

OHBCBS-CDCRCM-081411-25-CPN81360