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 Claims Review for Oncology Drugs and Services for Medicare Advantage Members

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

We’re Updating Our Payment Systems to Help Improve Efficiencies

Effective April 28, 2025, we’ll upgrade our systems to modernize payment processing. These changes will help increase efficiencies and enhance the security of our payment technology.

Utilization Management Review Paused for Advanced Imaging Site of Care

Expanded utilization management reviews for Advanced Imaging Site of Care services are paused until further notice. This doesn’t impact prior authorization reviews for advanced imaging.

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.

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.

Looking for Help?

Do you know the fastest way to get a response on prior authorizations? Are you aware of the latest pharmacy drug updates, or do you have a claims question? You can find many answers on our provider website, including:

• The latest updates

• Details about tools to streamline billing and processes

• Tips for newly contracted providers

• Quick reference links

Contact Your Provider Relations Representative

If you have a question and can’t find an answer, our provider relations representatives are here to help. Email us or call 800‑722‑3730 and select Option 2 for network.

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.