Highlights

Key Updates

AdministrativeSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 25, 2025

Reminder: Inpatient Readmissions Reimbursement Policy

Policy UpdatesSimply Healthcare Plans, Inc. - Florida Healthy KidsMarch 21, 2025

Carelon Medical Benefits Management, Inc. updates

Effective on May 1, 2025

Education & TrainingSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareMarch 20, 2025

Medication for opioid use disorder training opportunity

What's New

Recent Updates

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageApril 2, 2025

HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Medicare AdvantageApril 1, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 15, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Medicare AdvantageApril 1, 2025

Carelon Medical Benefits Management, Inc. updates

Effective May 3, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Medicare AdvantageApril 1, 2025

Carelon Medical Benefits Management, Inc. updates

Effective May 2, 2025

Policy Updates Medical Policy & Clinical GuidelinesSimply Healthcare Plans, Inc. - Florida Healthy KidsApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 1, 2025

Education & TrainingSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareApril 1, 2025

Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics

AdministrativeSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareApril 1, 2025

Important updates to preapproval requirements

Products & Programs PharmacySimply Healthcare Plans, Inc. - Florida Healthy KidsMarch 31, 2025

Quarterly pharmacy formulary change notice

Policy Updates Prior AuthorizationSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 26, 2025

Prior authorization requirement changes

Effective July 1, 2025

AdministrativeSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 25, 2025

Reminder: Inpatient Readmissions Reimbursement Policy

Policy UpdatesSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareMarch 25, 2025

Clinical Criteria updates

Effective May 27, 2025

Policy Updates Prior AuthorizationSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareMarch 24, 2025

Prior authorization requirement changes
Effective May 1, 2025

Policy Updates Prior AuthorizationSimply Healthcare Plans, Inc. - Florida Healthy KidsMarch 24, 2025

Prior authorization requirement changes
Effective May 1, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Florida Healthy KidsMarch 21, 2025

Carelon Medical Benefits Management, Inc. updates

Effective on May 1, 2025

Education & TrainingSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareMarch 20, 2025

Medication for opioid use disorder training opportunity

AdministrativeSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareMarch 19, 2025

Technical difficulties: My Diverse Patients

Products & Programs PharmacySimply Healthcare Plans, Inc. - Medicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 14, 2025

Controlling High Blood Pressure (CBP) 2025

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 13, 2025

Glycemic Status Assessment for Patients with Diabetes (GSD) 2025

Education & TrainingSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareMarch 12, 2025

You are invited: provider coding education

Policy Updates Medical Policy & Clinical GuidelinesSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 11, 2025

Care for Older Adults (COA) 2025

Education & TrainingSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareMarch 7, 2025

Resources to support diverse patients and communities

Policy Updates Prior AuthorizationSimply Healthcare Plans, Inc. - Medicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Products & Programs PharmacySimply Healthcare Plans, Inc. - Florida Healthy KidsMarch 4, 2025

March 2025 quarterly pharmacy formulary change notice

Administrative Digital SolutionsSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareMarch 1, 2025

Reminder: provider data attestation

Products & Programs PharmacySimply Healthcare Plans, Inc. - Medicare AdvantageFebruary 28, 2025

Important change to your patients’ specialty prescriptions

Administrative Digital SolutionsSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency

Policy UpdatesSimply Healthcare Plans, Inc. - Medicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Florida Healthy KidsFebruary 26, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareFebruary 26, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy Updates Prior AuthorizationSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 25, 2025

Prior authorization updates effective January 15, 2025

Products & Programs PharmacySimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 24, 2025

Preapproval updates for medications billed under the medical benefit

Effective April 1, 2025
Amtagvi and Nexobrid

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageFebruary 21, 2025

Advanced Illness and Frailty Exclusions 2025

AdministrativeSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareFebruary 21, 2025

Opportunity to provide telemedicine through the Capacity Building Grant

Policy Updates Medical Policy & Clinical GuidelinesSimply Healthcare Plans, Inc. - Medicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Products & ProgramsSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 18, 2025

Social Drivers of Health Provider Incentive Program (SDOHPIP)

Policy Updates Medical Policy & Clinical GuidelinesSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 17, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Medicare AdvantageFebruary 14, 2025

Clinical Criteria updates

Effective March 24, 2025

AdministrativeSimply Healthcare Plans, Inc. - Medicare AdvantageSimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 1, 2025

New Communication Center added to Availity Essentials

Quality ManagementSimply Healthcare Plans, Inc. - Medicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Policy UpdatesSimply Healthcare Plans, Inc. - Florida Healthy KidsJanuary 31, 2025

Clinical Criteria updates

Effective March 7, 2025

Policy UpdatesSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareJanuary 31, 2025

Clinical Criteria updates

Effective March 7, 2025

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Products & Programs PharmacySimply Healthcare Plans, Inc. - Medicaid Managed CareJanuary 14, 2025

Quarterly pharmacy formulary change notice

AdministrativeSimply Healthcare Plans, Inc. - Medicaid Managed CareClear Health Alliance - Medicaid Managed CareJanuary 14, 2025

Simply Healthcare Plans, Inc. wins statewide contract

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageJanuary 13, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality ManagementSimply Healthcare Plans, Inc. - Medicare AdvantageJanuary 13, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageJanuary 13, 2025

Colorectal Cancer Screening (COL‑E) 2025

Quality Management Optimizing HEDIS & STARSSimply Healthcare Plans, Inc. - Medicare AdvantageJanuary 12, 2025

Medication Adherence 2025