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.

Alacura to Manage Medical Transportation for Teacher Retirement System

Effective June 1, 2025, Alacura Medical Transportation Management will manage air and ground medical transportation, prior authorization and recommended clinical review for TRS members.

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.

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.

Prior Authorization Exemptions Reviewed for July 1 through Dec. 31, 2024

The latest exemption reports are now on Availity^® Essentials. Check to see if you qualify for exemptions resulting from the review of prior authorizations submitted from July 1 to Dec. 31, 2024.

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.

New Data on Quality Measures for Reporting Year 2023

Data for reporting year 2023 tracks rates on certain quality measures for members in our commercial HMO, PPO and marketplace HMO plans. Review a summary and interventions that impact them.

Doulas Provide Support for Expectant Parents

Doulas are trained caregivers who provide coaching and comfort during pregnancy and the postpartum period. Learn how our members can access doulas and other resources.

Stay Updated on Medicaid News

You can find information for STAR, STAR Kids and CHIP on our Medicaid News and Updates page.

2023 Program Results for Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM

Every year, we measure how we’re meeting the goals for our Dual Care program, which serves older adults and people with disabilities. See our results for 2023.

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.

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.