Education and Residency Information Required for Directory

Physicians (MDs and DOs) must provide us with their medical college and residency information by May 1, 2025. Review how to update and verify your information.

Encourage Follow‑up Care After Hospital Visits for Mental Health

Among Americans ages 18 to 44, nearly 600,000 are hospitalized yearly for mental health‑related conditions, according to the National Alliance on Mental Illness. You can help our members by encouraging timely follow‑up care with behavioral health care providers when appropriate.

Watch for Updates to Government Programs Claims Review for Oncology Drugs and Services

Effective June 1, 2025, we’ll enhance our claims editing and review process for some oncology drugs and associated services for Medicare Advantage and Medicaid members. See what’s changing and what you may need to do to prepare.

Procedure Code and Fee Schedule Update

On June 1, 2025, we’ll update the Schedule of Maximum Allowances, including durable medical equipment supplies, prosthetics, orthotics and clinical laboratory codes. This update affects professional providers in PPO and Blue Choice PPO^SM networks. View details and reminders on how to request fee schedule information.

Discuss Colon Health and Preventive Screening with Our Members

Preventive screening for colorectal cancer is recommended for adults ages 45 to 75. Review screening tests and tips to close care gaps.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Sign up now for orientations and webinars on Medicare Advantage and more.

Has Your Information Changed? Update Us and the NPI Registry

Update the National Provider Identifier Registry and us if your practice address, phone number or other demographic information changes.

CDC Recommends Prescribing Doxy PEP to Prevent STIs

This medication helps reduce the risk of syphilis, which has been on the rise in Illinois, according to the Illinois Department of Public Health. Review what you can do to help increase patient awareness and promote preventive care.

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. Learn more about what’s changing, effective April 1, 2025.

Pharmacy Program Quarterly Update — Part 1

Effective April 1, 2025, changes will be made to our drug lists and utilization management program. Review these and other pharmacy benefit program updates.

Clinical Payment and Coding Policy Updates

We regularly add and modify our Clinical Payment and Coding Policies as part of our ongoing policy review. Learn about the policies that were updated.

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.