CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025

April 2025 Provider Newsletter

Featured Articles

PharmacyMedicare AdvantageFebruary 28, 2025

Important change to your patients’ specialty prescriptions

Effective April 1, 2025

Administrative

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency

Education & Training

Education & TrainingCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025

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

Education & TrainingCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Education & TrainingCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsFebruary 28, 2025

Resources to support diverse patients and communities

Policy Updates

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsFebruary 26, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesMedicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsMarch 24, 2025

Carelon Medical Benefits Management, Inc. updates

Effective on May 1, 2025

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsMarch 28, 2025

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

Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Prior AuthorizationMedicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Prior AuthorizationMedicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Reimbursement PoliciesCommercialApril 1, 2025

Clarification to reimbursement policy: Incident to Services and Billing — Professional

Products & Programs

PharmacyCommercialMarch 27, 2025

Specialty pharmacy updates — April 2025

PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

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