Encourage Annual Eye Exams for Members with Diabetes

Early detection and treatment can greatly lower the risk of vision loss and eye diseases. See tips to close care gaps and coordinate care.

See Changes to Behavioral Health Utilization Management Program

The Illinois Health Care Protection Act establishes new requirements, effective Jan. 1, 2026, regarding utilization management and notification of behavioral health treatment.

Review Billing and Supervision Reminders for Behavioral Health Services Provided by Unlicensed Trainees

We reimburse for covered services provided by behavioral health master’s and doctoral level interns and postdoctoral fellows working toward clinical state licensure under the clinical supervision of a fully licensed contracted provider. See additional reminders.

Medicaid Reminder: Carelon Rehabilitation Prior Authorizations Reflect Care in Units

For members with Blue Cross Community Health Plans^SM, you’ll receive approvals for physical, occupational and speech therapy in units, not number of visits. Learn about submitting requests to Carelon Medical Benefits Management.

Watch for Updates to Availity^® Essentials Claim Status Tool

With November’s updates, you’ll experience consistent tool options with multiple payers when verifying real‑time claim status for members.

Take Note of Paid Claims Editing Enhancements for Medicaid and Medicare Advantage

Beginning in February 2026, we’ll enhance our claims editing and review process for some members to ensure services are properly reimbursed.

Watch for Procedure Code and Fee Schedule Updates

On Jan. 1, 2026, we’ll implement Current Procedural Terminology (CPT^®) and Healthcare Common Procedure Coding System procedure code additions, deletions and revisions.

Review Prior Authorization Changes for Commercial and Government Plans

Effective Jan. 1, 2026, prior authorization requirements for certain commercial and government plans are changing to reflect new, replaced or removed codes.

See Annual Healthcare Effectiveness Data and Information Set (HEDIS^®) Reports

The reports for our commercial HMO and PPO networks include measures across domains of care reflecting effectiveness, access, availability and utilization.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Upcoming sessions include a behavioral health provider webinar on autism spectrum disorder offering continuing education credit. View the schedule and sign up.

Talk with Members About Access to Contraceptive Care

For members with BCCHP^SM, we track a U.S. Department of Health and Human Services’ quality measure on contraceptive care to help close potential care gaps. Learn what data is measured.

Verify Your Directory Information Every 90 Days

Our members rely on our provider directory for accurate information about your practice. Review and verify your data every 90 days and update it when it changes.

Review Updates on Managing Your Data in Availity Essentials

The Provider Data Management tool is updated with a new look and more uniform workflow for you to quickly update and verify your information with us. See what’s changed.

Help Fight Fraud, Waste and Abuse by Filing Accurate Claims

To help ensure that claims are processed accurately and efficiently, review the billing guidelines in the Claim Filing and Claim Submission section of our Commercial Provider Manual.

Review Pharmacy Program Quarterly Update – Part 2

Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

See the Latest Pharmacy Prior Authorization Changes

We’re updating our standard pharmacy prior authorization programs. Changes affect members with prescription drug benefits administered by Prime Therapeutics^®. Review what’s changing as of Dec. 1, 2025.

See New Coding Policy on Psychiatry and Psychotherapy Services

Effective Dec. 22, 2025, we’ll implement a new Clinical Payment and Coding Policy, CPCP051 Psychiatry/Psychotherapy Services‑Professional Provider, with billing and coding guidance.

Learn About Updates to Clinical Payment and Coding Policies

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

Review Active and Pending Medical Policies

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.