What's New

Recent Updates

Education & TrainingMedicaidMay 23, 2024

Disbursement Payments for Memorial Day Holiday

Education & TrainingMedicaidDecember 1, 2023

Practitioners’ rights during credentialing process

Quality ManagementMedicaidOctober 31, 2023

Healthy blood pressure recheck initiative

Policy Updates Reimbursement PoliciesMedicaidOctober 31, 2023

Genetic Tests: Once per Lifetime

AdministrativeMedicaidOctober 31, 2023

Healthy Blue contract expiring after December 31, 2023

Quality ManagementMedicaidOctober 10, 2023

Healthy Blood Pressure Re-Check Initiative

Administrative Digital SolutionsMedicaidOctober 1, 2023

Introducing Roster Automation to improve turnaround times and data accuracy

Education & Training WebinarsMedicaidSeptember 22, 2023

You're invited: Thriving, not just surviving: Youth mental health in today's world

Policy UpdatesMedicaidSeptember 17, 2023

Clinical Criteria updates - February 2023

Products & Programs PharmacyMedicaidSeptember 14, 2023

Quarterly Pharmacy Formulary Changes effective November 1, 2023

Quality ManagementMedicaidSeptember 1, 2023

Congenital syphilis is a sentinel health event

AdministrativeMedicaidAugust 18, 2023

Quarterly pharmacy formulary changes effective April 1, 2023

AdministrativeMedicaidAugust 17, 2023

Skilled Nursing Facility Billing Guide update

Products & Programs PharmacyMedicaidAugust 16, 2023

PA update - Altuviiio

Products & Programs PharmacyMedicaidAugust 3, 2023

Quarterly Pharmacy Formulary Changes effective August 1, 2023

Policy Updates Prior AuthorizationMedicaidAugust 1, 2023

Carelon MSK - Joint & Spine surgery code updates effective November 1, 2023

Policy Updates Prior AuthorizationMedicaidAugust 1, 2023

Carelon Medical Benefits Management, Inc. Genetic Testing CPT Code List update

Policy Updates Medical Policy & Clinical GuidelinesMedicaidAugust 1, 2023

Transition to Carelon Medical Benefits Management, Inc. MRI Breast Clinical Appropriateness Guidelines

AdministrativeMedicaidAugust 1, 2023

Unspecified diagnosis code of site and laterality

Policy Updates Reimbursement PoliciesMedicaidAugust 1, 2023

Technology Assisted Surgical Procedures

Policy Updates Prior AuthorizationMedicaidAugust 1, 2023

Spevigo and Xenpozyme Medical Prior Authorization update

Quality ManagementMedicaidAugust 1, 2023

Members’ Rights and Responsibilities

Policy Updates Prior AuthorizationMedicaidAugust 1, 2023

Medical Prior Authorization Update - Fylnetra, Rolvedon, and Stimufend

Quality ManagementMedicaidAugust 1, 2023

Complex Care Management program

Quality ManagementMedicaidJuly 28, 2023

Pharmacotherapy Management of COPD Exacerbation HEDIS measure

Policy Updates Prior AuthorizationMedicaidJuly 27, 2023

Cimerli Medical Prior Authorization update

Policy Updates Prior AuthorizationMedicaidJuly 26, 2023

Prior authorization requirement changes effective November 1, 2023

Policy Updates Medical Policy & Clinical GuidelinesMedicaidJuly 24, 2023

Clinical Criteria updates - December 2022

Products & Programs PharmacyMedicaidJuly 14, 2023

Generic insulin products

Products & Programs PharmacyMedicaidJuly 12, 2023

Upcoming changes: The Medication Access and Training Expansion Act

Products & Programs State Health Benefit PlanMedicaidJuly 10, 2023

External Cause of Morbidity New Claim Edit Process

Policy UpdatesMedicaidJuly 3, 2023

Clinical Criteria updates - September 2022

Policy UpdatesMedicaidJune 30, 2023

Clinical Criteria updates November-December 2022

AdministrativeMedicaidJune 30, 2023

Important information about utilization management

Education & TrainingMedicaidJune 30, 2023

HEDIS® telehealth eligible measures coding bulletin

Products & Programs PharmacyMedicaidJune 30, 2023

Long-acting injectable antipsychotics

Policy UpdatesMedicaidJune 30, 2023

MCG Care Guidelines 27th edition