Highlights

Key Updates

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 28, 2025

FAMIS formulary and Preferred Drug List update


What's New

Recent Updates

Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialFebruary 18, 2025

MCG Care Guidelines 29th edition

Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 17, 2025

MCG Care Guidelines 29th edition

Guideline UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Developmental screening in the first three years of life

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 11, 2025

Chlamydia Screening (CHL) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialFebruary 10, 2025

Colorectal Cancer Screening (COL-E) 2025

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialFebruary 4, 2025

Expansion of Carelon Medical Benefits Management, Inc. programs

Products & Programs Federal Employee Program (FEP)Anthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Corrected claim guidance for the Federal Employee Program®

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 1, 2025

New Communication Center added to Availity Essentials

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Clinical Criteria updates for specialty pharmacy are available

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 1, 2025

Quarterly pharmacy formulary change notice

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Pharmacy information available on our provider website

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 1, 2025

Claims billing education: Medicaid secondary billing errors

AdministrativeAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Medical records needed for accurate payment of certain facility inpatient claims

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 31, 2025

Clinical Criteria updates

Effective March 7, 2025

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 30, 2025

Important update: group billable status for FQHCs and RHCs

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 28, 2025

FAMIS formulary and Preferred Drug List update

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialJanuary 27, 2025

Key formulary updates: effective January 1, 2025

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 23, 2025

You are invited: Provider coding education

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 22, 2025

Breast Cancer Screening (BCS-E) 2025

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialJanuary 22, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 21, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 21, 2025

Controlling High Blood Pressure (CBP)

Quality ManagementAnthem Blue Cross and Blue Shield | CommercialJanuary 17, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 16, 2025

Asthma Medication Ratio (AMR) 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJanuary 16, 2025

Submitting authorization for NICU services facilitates accurate and timely claims processing

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 16, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Products & Programs Federal Employee Program (FEP)Anthem Blue Cross and Blue Shield | CommercialJanuary 14, 2025

Authorization for post‑acute care services for FEP members

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 13, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 13, 2025

Colorectal Cancer Screening (COL‑E) 2025

Quality ManagementAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 13, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 13, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 12, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 9, 2025

Advanced Illness and Frailty 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 9, 2025

Transition of Care (TRC) 2025

Quality ManagementAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 8, 2025

Breast Cancer Screening (BCS-E) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 7, 2025

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

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 6, 2025

Prior authorization updates for medications billed under the medical benefit

Effective March 1, 2025
Kisunla and Piasky

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 6, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | CommercialJanuary 6, 2025

HEDIS Desktop Reference Guide for Commercial 2025

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 1, 2025

New year, new labs: LabCorp and Quest Diagnostics now in‑network for Virginia plans

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

AdministrativeHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 1, 2025

Updates to correct coding editing

AdministrativeHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJanuary 1, 2025

Important updates regarding COVID-19 vaccine and testing policies

Products & ProgramsAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

Introducing Coupe Health — quality care with clear pricing and no upfront payments

AdministrativeAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2025

CAA: Providers required to verify online provider directory information