PEAQ^SM Program Adds New Specialties for Cost Efficiency Analysis

As of Jan. 1, 2025, the Physician Efficiency, Appropriateness, & Quality^SM program includes 23 new specialties for the cost efficiency component. Learn how this change affects what members see when searching for information on Provider Finder^®.

Remind Billing Agencies to Correctly Submit Claim Review Requests

Agencies may submit requests using our claim review form or, for faster processing, submit requests electronically through Availity^® Essentials. Learn tips on how to complete submissions and avoid returned requests.

ClaimsXten^TM Quarterly Update

We’ll implement first quarter code updates for the ClaimsXten auditing tool on or after March 17, 2025.

Prior Authorization Changes

Effective April 1, 2025, prior authorization requirements are changing to reflect new, replaced or removed codes. Learn about the changes for commercial non‑HMO members and for members of Blue Cross Medicare Advantage (PPO)^SM, Blue Cross Community Health Plans^SM and Blue Cross Community MMAI (Medicare‑Medicaid Plan)^SM.

Medical Records Needed to Support Quality Care

You may receive requests in 2025 for our members’ medical records. We collect data for Healthcare Effectiveness Data and Information Set (HEDIS^®) measures to track quality of care. Learn how you can help by promptly providing complete records for Federal Employee Program^® and Medicare Advantage members.

Follow‑Up Care Is Recommended for Children Prescribed ADHD Medication

Attention‑deficit/hyperactivity disorder is one of the most common behavioral health disorders affecting children. To support quality care, we gather data on follow‑up visits for children using ADHD medication.

Remind Our Members About Cervical and Breast Cancer Screenings

Regular screening tests can help detect cancer early when it’s easier to treat. Learn about documenting these screenings in members’ medical records and other tips to close gaps in care.

New Gene Therapy Solutions Helps Monitor Results

We launched gene therapy solutions on Jan. 1, 2025, to support access to care while protecting against high treatment costs for our commercial group members. To help track clinical outcomes, we may ask you for information about the effectiveness of gene therapy treatments prescribed for our members.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Upcoming sessions include training on electronic tools and orientation.

New Part D Quality Measures Track High‑Risk Medication Combinations

The Centers for Medicare & Medicaid Services added two quality measures to its Star Ratings for Medicare prescription drug plans. Learn more about the measures and the risks of concurrent use.

Update Your Records for New Members of Blue Cross Group Medicare Advantage Open Access (PPO)^SM

New Medicare‑eligible retirees have joined our Blue Cross Group Medicare Advantage Open Access (PPO) plan for retirees of employer groups. If you’re a Medicare provider, you may treat these members even if you don’t participate in our Medicare Advantage or other networks.

Blue Choice Options^SM PPO Offers Tiered Benefit Levels

Blue Choice Options PPO is a tiered product designed to help employer groups and members manage their health care spending. All PPO participating providers and Blue Choice PPO^SM participating providers are in‑network for members with Blue Choice Options.

Ensure Your Office Is Providing Your Most Current Information

When seeking care, our members may contact your office or search our online Provider Finder for information such as your appointment availability for new patients. Learn how to ensure our members can access the most up‑to‑date information.

Keep Your Contact Information Updated to Receive Recredentialing Reminders

Providers credentialed with us are required to recredential every three years. Keep your information updated with us and the Council for Affordable Quality Healthcare to receive reminders and ensure we’re able to obtain your recredentialing application with CAQH.