May 1, 2025

May 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid

Featured Articles

Education & TrainingMedicare AdvantageApril 29, 2025

Join our D-SNP network to better serve dual-eligible patients

Quality ManagementMedicaidMay 1, 2025

Join our medical committee to help shape healthcare innovations

Administrative

AdministrativeCommercialMay 1, 2025

Direct HMO: Understanding the network design

AdministrativeCommercialMedicaidApril 29, 2025

Ensuring timely attention to expedited grievances and appeals

AdministrativeCommercialMay 1, 2025

Unlock the power of electronic claims with Availity Essentials

AdministrativeCommercialMay 1, 2025

Annual grievance and appeals attestation requirement

Digital SolutionsCommercialMedicare AdvantageMedicaidMay 1, 2025

Reminder: New Communication Center added to Availity Essentials

Education & Training

Education & TrainingCommercialMay 1, 2025

Free CE training: Lifestyle Medicine & Food as Medicine Essentials Course

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Education & TrainingCommercialMay 1, 2025

Effortless eligibility checks with the Patient Search Option in Availity

Education & TrainingMedicaidMay 1, 2025

Enhancing your learning experience: latest updates in Provider Pathways

Policy Updates

Policy UpdatesMedicaidApril 3, 2025

Clinical Criteria updates

Effective July 7, 2025

Policy UpdatesMedicaidApril 9, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 10, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Medical Policy & Clinical GuidelinesMedicaidApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageApril 30, 2025

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective August 1, 2025

Prior AuthorizationMedicaidApril 4, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Products & Programs

PharmacyMedicare AdvantageApril 16, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

PharmacyMedicare AdvantageApril 16, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

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