What's New

Recent Updates

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 8, 2025

Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 7, 2025

Advanced Illness and Frailty 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 6, 2025

Adult Immunization Status (AIS‑E) 2025

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

Quality Management Optimizing HEDIS & STARSMedicare AdvantageNovember 26, 2024

HEDIS Category II Coding Bulletin 2025

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

Quality ManagementMedicare AdvantageOctober 29, 2024

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

Quality ManagementMedicare AdvantageOctober 25, 2024

Time to prepare for HEDIS medical record review

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 23, 2024

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

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 22, 2024

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

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

Quality ManagementMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Products & Programs PharmacyMedicare AdvantageOctober 6, 2024

Improving patient outcomes: back to the basics

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

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

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

Education & Training WebinarsMedicare AdvantageOctober 2, 2024

You are invited: Annual planned visits for Medicare patients webinar

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 1, 2024

County of Delaware launches Blue Medicare Advantage PPO plan for retirees in 2025

Policy Updates Prior AuthorizationMedicare AdvantageSeptember 24, 2024

Prior authorization requirement changes

Effective February 1, 2025

Policy Updates Prior AuthorizationMedicare AdvantageSeptember 23, 2024

Prior authorization requirement changes

Effective January 1, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageSeptember 23, 2024

Osteoporosis Management in Women Who Had a Fracture (OMW) 2025

Products & Programs PharmacyMedicare AdvantageSeptember 19, 2024

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

Quality Management Optimizing HEDIS & STARSMedicare AdvantageSeptember 19, 2024

HEDIS Measure Tips — Osteoporosis Screening in Older Women (OSW) 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageSeptember 10, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective October 10, 2024

Policy UpdatesMedicare AdvantageSeptember 3, 2024

Clinical Criteria updates

Effective October 6, 2024

Products & ProgramsMedicare AdvantageAugust 28, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Products & Programs PharmacyMedicare AdvantageAugust 27, 2024

BMA expands specialty pharmacy precertification list

Codes: C9399, J9999 and J3590

Administrative Digital SolutionsMedicare AdvantageAugust 22, 2024

Advancing digital efficiency by discontinuing paper remittances

AdministrativeMedicare AdvantageAugust 20, 2024

Drug and biologic

Quality ManagementMedicare AdvantageAugust 13, 2024

Announcing the new HEDIS documentation library supporting coding excellence

Products & Programs PharmacyMedicare AdvantageAugust 12, 2024

BMA expands specialty pharmacy precertification list

Products & Programs PharmacyMedicare AdvantageAugust 9, 2024

Real-time prescription benefit

Education & Training WebinarsMedicare AdvantageAugust 8, 2024

You are invited: HEDIS immunization measures: strategies for improving performance

Administrative Digital SolutionsMedicare AdvantageAugust 8, 2024

Digital-only authorization case status notification coming to you

Policy Updates Prior AuthorizationMedicare AdvantageAugust 1, 2024

Prior authorization requirement changes

Effective December 1, 2024