What's New

Recent Updates

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

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJuly 26, 2024

HEDIS 2024 updates: exclusive insights on advanced illness and frailty exclusions

Administrative Digital SolutionsMedicare AdvantageJuly 24, 2024

Save time and get better results with optimized CPT code search in Availity Essentials

AdministrativeMedicare AdvantageJuly 18, 2024

ICD-10-CM Excludes1 notes

Administrative Digital SolutionsMedicare AdvantageJuly 16, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 11, 2024

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

Policy UpdatesMedicare AdvantageJuly 10, 2024

Clinical Criteria updates

Effective August 12, 2024

Administrative Digital SolutionsMedicare AdvantageJuly 9, 2024

Coming soon — digital-only authorization case status notifications

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Quality ManagementMedicare AdvantageJune 24, 2024

Follow-up After Hospitalization for Mental Illness (FUH)

Quality ManagementMedicare AdvantageJune 24, 2024

Pharmacotherapy management of COPD exacerbation (PCE)

Quality ManagementMedicare AdvantageJune 24, 2024

Follow-up After Emergency Department Visit for Substance Use (FUA)

Quality ManagementMedicare AdvantageJune 24, 2024

Use of Imaging Studies for Low Back Pain (LBP)

Quality ManagementMedicare AdvantageJune 24, 2024

Blood Pressure Control for Patients With Diabetes (BPD)