What's New

Recent Updates

Administrative Digital SolutionsMedicare AdvantageJune 11, 2025

Streamlining behavioral health authorizations via Availity Essentials

Education & TrainingMedicare AdvantageJune 3, 2025

Combat diabetes: Close the statin therapy gap for better heart health

Policy Updates Prior AuthorizationMedicare AdvantageJune 3, 2025

Precertification/prior authorization requirement changes

Effective October 1, 2025

Products & Programs PharmacyMedicare AdvantageJune 3, 2025

National Drug Codes (NDC) are required for outpatient claims

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Education & Training WebinarsMedicare AdvantageMay 30, 2025

Join the 2025 Clinical Quality in Practice webinar series

Quality ManagementMedicare AdvantageMay 27, 2025

Bridging the gap: Enhancing medication adherence for better health outcomes

Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Education & TrainingMedicare AdvantageMay 22, 2025

Claims guidance: updating inpatient and outpatient bill types

Education & TrainingMedicare AdvantageMay 19, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

Products & Programs PharmacyMedicare AdvantageMay 9, 2025

Heart health spotlight: leveraging statin therapy for diabetes

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 30, 2025

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

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

AdministrativeMedicare AdvantageApril 22, 2025

Additional drug codes added to medical claims edit system

Products & Programs PharmacyMedicare AdvantageApril 16, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

Products & Programs PharmacyMedicare AdvantageApril 16, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

Policy Updates Prior AuthorizationMedicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Products & Programs PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

AdministrativeMedicare AdvantageMarch 19, 2025

Technical difficulties: My Diverse Patients

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Policy Updates Prior AuthorizationMedicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Products & Programs PharmacyMedicare AdvantageMarch 3, 2025

Important change to your patients’ specialty prescriptions

Education & TrainingMedicare AdvantageFebruary 28, 2025

Resources to support diverse patients and communities

Policy UpdatesMedicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Policy UpdatesMedicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

AdministrativeMedicare AdvantageJanuary 23, 2025

Steamfitters Local Union No. 420 retirees join our PPO plan

Quality ManagementMedicare AdvantageJanuary 23, 2025

2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

Products & Programs PharmacyMedicare AdvantageDecember 30, 2024

Kroger Specialty Pharmacy acquisition

Administrative Digital SolutionsMedicare AdvantageDecember 30, 2024

Enhance patient coordination with Total Member View

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 19, 2024

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

Products & Programs PharmacyMedicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

Products & Programs PharmacyMedicare AdvantageNovember 19, 2024

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

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

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Policy UpdatesMedicare AdvantageOctober 16, 2024

Carelon Medical Benefits Management, Inc. updates

Effective November 17, 2024

Education & Training WebinarsMedicare AdvantageOctober 15, 2024

You are invited: real-time prescription benefit webinar

Administrative Digital SolutionsMedicare AdvantageOctober 14, 2024

Save time with new CPT code search functionality

Products & Programs PharmacyMedicare AdvantageOctober 6, 2024

Improving patient outcomes: back to the basics

Education & Training WebinarsMedicare AdvantageOctober 2, 2024

You are invited: Annual planned visits for Medicare patients webinar