Highlights

Key Updates

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMarch 19, 2025

Technical difficulties: My Diverse Patients

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMarch 3, 2025

Important information about specialty prescriptions

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 28, 2025

Important change to your patients’ specialty prescriptions

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency


What's New

Recent Updates

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMarch 19, 2025

Technical difficulties: My Diverse Patients

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 14, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Quality Management Optimizing HEDIS & STARSAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 14, 2025

Controlling High Blood Pressure (CBP) 2025

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

Care for Older Adults (COA) 2025

Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMarch 3, 2025

Important information about specialty prescriptions

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

Streamline your workflow with Care Central on Availity Essentials

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

Changes in Postal Service Health Benefits for 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

New coding guidelines: include the anatomic modifier

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Precertification list change notification March 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Update: Drug claims edits to focus on FDA‑approved indications

Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

Coverage Guideline update — June 1, 2025

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

Clinical Criteria updates for specialty pharmacy are available

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 1, 2025

Reminder: provider data attestation

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 28, 2025

Important change to your patients’ specialty prescriptions

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 28, 2025

Resources to support diverse patients and communities

Administrative Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency

Guideline UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 26, 2025

Clinical Criteria updates

Effective March 28, 2025

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 25, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Orencia and Avsola

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 24, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Tevimbra and Tyenne

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

Advanced Illness and Frailty Exclusions 2025

Products & Programs Long-Term Services & SupportsHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 21, 2025

You are invited: provider office hours scheduled for CCC Plus Waiver Providers and Nursing Facilities

Education & Training WebinarsAnthem Blue Cross and Blue Shield | CommercialFebruary 21, 2025

Start 2025 with an easy way to earn continuing education credits

Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

AdministrativeHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 20, 2025

Doula and OB delivery claim denials

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 19, 2025

Prior authorization updates for medications billed under the medical benefit

Effective April 1, 2025
Anktiva, Hercessi, and Imdelltra

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

MCG Care Guidelines 29th edition

Effective June 1, 2025

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

MCG Care Guidelines 29th edition

Effective June 1, 2025

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 PharmacyAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Pharmacy information available on our provider website

AdministrativeAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Medical records needed for accurate payment of certain facility inpatient claims

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

Claims billing education: Medicaid secondary billing errors

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 productsFebruary 1, 2025

Quarterly pharmacy formulary change notice

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

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