May 1, 2025

May 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI Programs

Featured Articles


Administrative

AdministrativeMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 1, 2025

Additional drug codes added to medical claims edit system

Education & Training

Education & TrainingBadgerCare Plus and Medicaid SSI ProgramsMay 1, 2025

Enhancing your learning experience: latest updates in Provider Pathways

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Policy Updates

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsApril 3, 2025

Clinical Criteria updates

Effective May 7, 2025

Medical Policy & Clinical GuidelinesCommercialApril 10, 2025

Medical Policies and Clinical Guidelines updates, May 2025

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 1, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageApril 30, 2025

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

Effective August 1, 2025

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsApril 11, 2025

Prior authorization requirement changes

Effective June 1, 2025
Codes: J9248 and L5841

Products & Programs

PharmacyBadgerCare Plus and Medicaid SSI ProgramsApril 29, 2025

New preapproval requirements for Givlaari

Effective June 1, 2025

PharmacyMedicare AdvantageApril 18, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

PharmacyMedicare AdvantageApril 18, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost


WIBCBS-CDCRCM-081416-25-CPN81360