Quality Measures Help Track Our Members’ Heart Health

Heart disease and stroke are among the leading causes of death in the U.S. We track measures related to our members’ blood pressure control and statin therapy. Learn steps to help identify and close care gaps.

Avoid Inappropriate Use of Antipsychotic Medication for Anxiety Disorders

Most antipsychotic medications aren’t approved for the treatment of anxiety disorders. We encourage prescribing providers to carefully assess symptoms, risks and benefits when considering medications for our members with anxiety disorders.

Postponed: Updates to Behavioral Health Substance Use Criteria for Utilization Management

We’ll continue to apply criteria from the American Society of Addiction Medicine’s third edition in our medical necessity reviews for substance use services for adults and adolescents.

Earn Continuing Education Credit in Courses on Maternal Mental Health

You can access March of Dimes^® e‑learning modules on maternal mental health and perinatal loss at no cost through May 13, 2025.

Annual Survey Monitors Our Members’ Health Care Experiences

Every year, some of our Medicare Advantage members receive the Consumer Assessment of Healthcare Providers and Systems survey. It asks them to rate their experiences with their health care providers and plans. Learn about survey topics our members may discuss with you.

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

QMB patients are eligible for both Medicare and Medicaid. If you participate in Blue Cross Medicare Advantage^SM, you may not bill our members enrolled in the QMB program. Learn precautions to take to avoid billing these members.

Hospitals Must Provide Notice to Members Under Outpatient Observation for More Than 24 Hours

Hospitals and critical access hospitals are required to give the standardized Medicare Outpatient Observation Notice to Medicare Advantage plan members who are under outpatient observation for more than 24 hours. The notice explains why the members aren’t inpatient and their cost‑sharing obligations.

Medical Record Collection for Commercial Members Begins in February

We collect data from providers to track quality of care. Learn how you can help by promptly providing complete medical records for our members.

Looking for Help? Contact Your Network Representative

Do you know the fastest way to get a response on prior authorizations? Are you aware of the latest pharmacy drug updates? Maybe you have other questions. Many of these answers are in our News and Updates, but if you need more information, our provider network representatives are here. Email us or call 800‑722‑3730 and select Option 2 for Network.

Pharmacy Program Quarterly Update – Part 2

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

Laboratory Management Clinical Payment and Coding Policies Updated

We’ve updated multiple Laboratory Management policies with a new code released by the American Medical Association, effective Jan. 1, 2025.

Clinical Payment and Coding Policy Updates

New or revised clinical payment and coding policies are on our Clinical Payment and Coding Policies page. These policies provide billing, coding and documentation guidelines. Visit our site regularly to ensure you’re up to date on any changes or new policies.

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 under the Standards and Requirements tab. 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.