Key Updates
MedicaidApril 4, 2025
Precertification/prior authorization requirement changes
Effective August 1, 2025
CommercialMedicare AdvantageMedicaidFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiency
Recent Updates
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines UpdateEffective May 25, 2025
MedicaidApril 21, 2025
2025 Clinical Practice Guidelines now availableMedicaidApril 18, 2025
Community-based adult services member ID prefix guidanceMedicaidApril 17, 2025
Improving maternal mental health: new screening protocolsCommercialMedicare AdvantageApril 16, 2025
Provider Training Opportunity: You are invited: strategies for enhancing cardiovascular care and managementMedicare AdvantageApril 16, 2025
New specialty pharmacy medical step therapy requirementEffective June 1, 2025
Hercessi
Medicare AdvantageApril 16, 2025
Specialty pharmacy preapproval list updateEffective August 1, 2025
Jubbonti; Wyost
Medicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsMedicaidApril 4, 2025
Precertification/prior authorization requirement changesEffective August 1, 2025
Medicare AdvantageApril 2, 2025
HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025MedicaidApril 1, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective July 1, 2025
CommercialApril 1, 2025
Reimbursement policy updates for facilitiesCommercialApril 1, 2025
Participate in our access to care surveys and Language Assistance ProgramCommercialMedicare AdvantageMedicaidApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsMedicare AdvantageMarch 28, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMedicaidMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Medicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
Medicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 3, 2025
Important change to your patients’ specialty prescriptionsCommercialMedicare AdvantageMedicaidMarch 1, 2025
Reminder: provider data attestationCommercialMarch 1, 2025
Practices improve patient access using NPs and PAsMedicaidMarch 1, 2025
Update to Clinical Practice GuidelinesCommercialMarch 1, 2025
Direct HMO now serving southern California countiesCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMedicare AdvantageMedicaidFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageMedicaidFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiencyMedicaidFebruary 24, 2025
Non-specialty mental health services Provider trainingMedicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education creditsCommercialFebruary 20, 2025
Weight management program overviewMedicaidFebruary 20, 2025
Initial Health Appointment Coding GuidanceCommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025CommercialFebruary 10, 2025
Colorectal Cancer Screening (COL-E) 2025