Key Updates
Medicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plans
CommercialMedicare AdvantageMedicaidMay 27, 2025
Boost your roster submission skills with Availity Essentials
MedicaidMay 1, 2025
Join our medical committee to help shape healthcare innovations
Medicare AdvantageApril 29, 2025
Join our D-SNP network to better serve dual-eligible patients
CommercialMedicare AdvantageMedicaidMarch 1, 2025
Reminder: provider data attestation
Recent Updates
Medicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMedicare AdvantageMedicaidMay 27, 2025
Boost your roster submission skills with Availity EssentialsCommercialMay 22, 2025
Action required: annual patient safety attestationMedicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
MedicaidMay 21, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 24, 2025
MedicaidMay 20, 2025
Prior authorization updates for medications billed under the medical benefitEffective September 1, 2025
Tevimbra and Tyenne
CommercialMedicare AdvantageMedicaidMay 1, 2025
Reminder: New Communication Center added to Availity EssentialsMedicaidMay 1, 2025
Enhancing your learning experience: latest updates in Provider PathwaysCommercialMay 1, 2025
Effortless eligibility checks with the Patient Search Option in AvailityCommercialMay 1, 2025
Direct HMO: Understanding the network designCommercialMay 1, 2025
Annual grievance and appeals attestation requirementCommercialMay 1, 2025
Unlock the power of electronic claims with Availity EssentialsCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsMedicaidMay 1, 2025
Join our medical committee to help shape healthcare innovationsCommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseMedicare AdvantageApril 30, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective August 1, 2025
Medicare AdvantageApril 29, 2025
Join our D-SNP network to better serve dual-eligible patientsCommercialMedicaidApril 29, 2025
Ensuring timely attention to expedited grievances and appealsMedicare 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 protocolsMedicare 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
MedicaidApril 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 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
Medicare AdvantageMarch 3, 2025
Important change to your patients’ specialty prescriptionsCommercialMarch 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 2025