Discuss Oral Hygiene as Part of Preventive Care for Children With Medicaid

Oral health screening is required as part of the Early and Periodic Screening, Diagnostic and Treatment program. View EPSDT reminders, quality measures and tips to consider.

We’re Removing Option To Request Recommended Clinical Review for Medical Necessity

To improve the efficiency of our utilization management program, we’ll begin removing recommended clinical review as an optional review for our commercial members, starting Jan. 1, 2027.

Watch for New Digital Interfaces To Simplify Prior Authorization Requests

Starting Jan. 1, 2027, we’ll offer application programming interfaces to simplify prior authorization requests and give you quicker access to your patients’ information.

Access Medicare Advantage Prior Authorization Decision Letters via Availity^® Essentials

Beginning Oct. 8, 2026, you’ll be able to view and securely download prior authorization decision letters for members with Medicare Advantage plans through the Provider Correspondence Viewer within Payer Spaces.

See Prior Authorization Changes for Some Commercial and Government Program Members

We’ve updated prior authorization requirements for some commercial members and government plans to reflect new, replaced or removed codes.

Encourage Routine Screening To Detect Breast Cancer Early

Breast cancer screening should begin at age 40 and continue every other year until age 74, according to the U.S. Preventive Services Task Force. See tips to close screening gaps.

Support Care Coordination After Hospital Discharges

When our members receive inpatient hospital care, hospital care teams can help coordinate care with primary care providers by sharing discharge summaries. View tips to support care coordination.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for sessions.

See Program Results for Blue Cross Medicare Advantage Dual Care^SM

Every year, we measure how we’re meeting the goals for our Dual Care programs, which serve older adults and people with disabilities. See the 2025 results for Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM and Blue Cross Medicare Advantage Dual Care Plus Preferred (PPO SNP)^SM.

Watch for New Edge Benefit Plan Members in 2027

Beginning Jan. 1, 2027, you may see members of our new Edge benefit plans, powered by Easify^SM. Edge plans are copay‑only PPO plans with tiered benefits based on which providers our members choose.

Learn About Updates to Reimbursement Policies

We regularly add and modify reimbursement policies, formerly known as clinical payment and coding policies, as part of our ongoing policy review. See which policies were updated.

Take Note of Provider Reference Manual Update

Our Medicare Provider Reference Manual   is updated. Changes to the manual include, but aren’t limited to, the following sections: 10 – Facility Claims Selection and Retention of Participating Physicians and Other Providers. Please review it for all changes.

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.