Encourage Medicare Members to Respond to Health Outcomes Survey

The Centers for Medicare & Medicaid Services surveys a sample of our members to rate their care. Learn about survey topics our members may discuss with you.

Postponed: Enhanced Claim Review for Oncology Drugs and Services

We’re delaying the enhancement of our claims editing and review process of some oncology drugs and services for our Medicare Advantage and Medicaid members.

Use Simplified Referral Form for American Indian and Alaska Native Limited Cost‑Share Plans

We’ve streamlined the claims referral form that Indian Health, Tribal and Urban Indian providers use to refer members of limited cost‑sharing plans to non‑I/T/U providers. Learn what’s changed.

ClaimsXten^TM Update

We’ll implement code updates for the ClaimsXten auditing tool on or after Aug. 18, 2025.

Encourage Routine Vaccines and Well‑Care Visits for Children and Adolescents

We track quality measures on immunizations for adolescents and preventive care visits for members ages 3 to 21. See tips to close care gaps.

See Updates to Clinical Practice and Preventive Care Guidelines

The guidelines are based on established evidence‑based standards and support decision‑making processes in member care.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. View the schedule and sign up for sessions, including training on coding for major depressive disorder.

Attend a Webinar to Prepare for Medicaid Prior Authorization Vendor Transition

Effective Aug. 1, 2025, Carelon Medical Benefits Management will replace EviCore healthcare for some prior authorization requests for our members with Blue Cross Community Health Plans^SM. There’s still time to sign up for training with Carelon on their portal.

Review Medical Billing Guidance for ABRYSVO^® RSV Vaccine for Pregnant Members with BCCHP^SM

Certain diagnoses codes must be used to enable payment for ABRYSVO vaccines for pregnant members with BCCHP. View details and instructions on submitting corrected claims for past denials with dates of service as early as Oct. 1, 2023.

Postponed: Changes to Notification Requirements for Hospital Admissions for Medicaid Members

We previously notified you about utilization management program changes to align with Illinois Senate Bill 3268 (PA 103‑0593). Recent legislation passed for Senate Bill 2437 delays many provisions in the bill.

Watch for Changes to Turnaround Time for Medicaid Prior Authorization Requests

Effective July 1, 2025, we’re adjusting the turnaround time for processing prior authorization requests for our members with BCCHP. Learn about changes for non‑urgent and urgent requests.

Code Effectively to Earn Additional Incentive Payments on Medicare Advantage Claims

Participating providers in our Medicare Advantage networks can earn an additional incentive payment when submitting claims with certain codes. See our updated list for details and incentive amounts.

Review Rights and Responsibilities

As a participating provider, you have certain rights and responsibilities that may affect your practice. Learn more about your rights and responsibilities and those of our members.

See the Latest Pharmacy Prior Authorization Changes

We’re making updates to our standard pharmacy prior authorization programs. Changes affect members with prescription drug benefits administered by Prime Therapeutics. Review what’s changing on Aug. 1, 2025.

Learn About Updates to Clinical Payment and Coding Policies

We regularly add and modify our CPCPs as part of our ongoing policy review. See which policies were updated and when.

Review Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.