Key Updates
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
BadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Earn CME credits: Attend our engaging webinars
Recent Updates
BadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Clinical Criteria updatesEffective August 3, 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialJuly 1, 2025
Reimbursement policy update: Bundled Services and Supplies — ProfessionalMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingCommercialJuly 1, 2025
A quick guide to understanding JW and JZ modifiersMedicare AdvantageJuly 1, 2025
A quick guide to understanding JW and JZ modifiersCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experienceCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataCommercialJuly 1, 2025
Update: essential ICD‑10‑CM compliance for outpatient facility claimsBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Earn CME credits: Attend our engaging webinarsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
National Drug Codes (NDCs) are required for professional and outpatient claimsMedicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expandedEffective November 1, 2025
Axtle, Bizengri, and Bynfezia pen
CommercialJune 25, 2025
Medical Policies and Clinical Guidelines updates — August 2025Medicare AdvantageJune 23, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansCommercialBadgerCare Plus and Medicaid SSI ProgramsJune 17, 2025
National Drug Code required for professional and facility outpatient claimsMedicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updatesBadgerCare Plus and Medicaid SSI ProgramsJune 13, 2025
Precertification/prior authorization requirement changesEffective August 1, 2025
Medicare AdvantageJune 3, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 3, 2025
National Drug Codes (NDC) are required for outpatient claimsCommercialJune 2, 2025
Specialty pharmacy updates: June 2025CommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Navigating health with confidence through the Complex Case Management programBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Learn about members’ rights and responsibilitiesBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Utilization management: prioritizing appropriate care and transparencyCommercialJune 1, 2025
Update to claims system for global surgical procedures for professional providersCommercialJune 1, 2025
You are invited: claims appeals on Availity EssentialsCommercialJune 1, 2025
Updated 2025 provider manual now availableMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Submitting BH authorizations in Availity EssentialsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launchMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialJune 1, 2025
Prior authorization for NICU services: Clinical UM Guideline availableCommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderCommercialMay 30, 2025
Key updates to the Designated Medical Specialty Pharmacy Drug ListBadgerCare Plus and Medicaid SSI ProgramsMay 28, 2025
Clinical Criteria updatesEffective June 30, 2025
Medicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 27, 2025
Boost your roster submission skills with Availity EssentialsMedicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
BadgerCare Plus and Medicaid SSI ProgramsMay 21, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective June 25, 2025
BadgerCare Plus and Medicaid SSI ProgramsMay 20, 2025
Prior authorization updates for medications billed under the medical benefitEffective July 1, 2025
Tevimbra and Tyenne
BadgerCare Plus and Medicaid SSI ProgramsMay 14, 2025
Carelon Medical Benefits Management, Inc. updatesEffective June 20, 2025
CommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseCommercialMay 1, 2025
Streamline your prior authorizations with our digital tools