Highlights

Key Updates

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

Reminder: provider data attestation


What's New

Recent Updates

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

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

Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 21, 2025

2025 Clinical Practice Guidelines

Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective June 25, 2025

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

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

Education & TrainingAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 20, 2025

Automated renewals for respite authorizations

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 15, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Boruzu, Nemluvio, Rytelo, Selarsdi, and Tecelra

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 14, 2025

Carelon Medical Benefits Management, Inc. updates

Guideline UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

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

Coverage and Clinical Guidelines update August 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Wellness visits may increase appointment scheduling For members enrolled in an ACA plan

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Free CE training: Lifestyle Medicine & Food as Medicine Essentials Course

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

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

Additional drug codes added to medical claims edit system

Behavioral HealthHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 1, 2025

FDA lifts risk evaluation and mitigation strategy reporting requirements for Clozapine

Guideline UpdatesAnthem Blue Cross and Blue Shield | CommercialMay 1, 2025

Clinical Criteria updates for specialty pharmacy are available

Effective August 1, 2025

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

Enhancing your learning experience: latest updates in Provider Pathways

Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 30, 2025

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

Effective August 1, 2025

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 29, 2025

New preapproval rules for medications

Effective June 1, 2025
Ebglyss, Lymphir, Niktimvo, and Ocrevus Zunovoa

AdministrativeHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 29, 2025

Important guidelines for avoiding common billing errors in DME claims

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 25, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 15, 2025

Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 19, 2025

Corrected ABA claim denials for codes 97152, 97153, and 97154

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 18, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 18, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageApril 11, 2025

Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute Solutions

Guideline Updates Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 11, 2025

Prior authorization requirement changes

Effective June 1, 2025
Codes: J9248 and L5841

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 4, 2025

Quarterly pharmacy formulary change notice

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 4, 2025

Quarterly pharmacy formulary change notice

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 3, 2025

Clinical Criteria updates

Effective May 7, 2025

Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 1, 2025

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

Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics

Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMarch 31, 2025

Virginia's Medical Preferred Drug List (PDL)/ Common Core Formulary

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialMarch 28, 2025

Streamline your workflow: Submit BH authorizations through Availity Essentials

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

Specialty pharmacy updates — April 2025

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Guideline Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 26, 2025

Prior authorization requirement changes

Effective July 1, 2025

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMarch 24, 2025

Carelon Medical Benefits Management, Inc. updates

Effective on May 1, 2025

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

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

Effective March 1, 2025

AdministrativeAnthem Blue Cross and Blue Shield | CommercialMarch 1, 2025

New coding guidelines: include the anatomic modifier

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

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

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

Clinical Criteria updates for specialty pharmacy are available

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

Coverage Guideline update — June 1, 2025