Key Updates
CommercialMedicare AdvantageMedicaidAugust 1, 2025
You are invited: immunization measures webinar
CommercialMedicare AdvantageMedicaidJuly 22, 2025
Enhance care provider data accuracy with updated roster tools
Recent Updates
Medicare AdvantageAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesCommercialAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesCommercialMedicare AdvantageMedicaidAugust 14, 2025
PCP IDs may change as part of HMO redesignMedicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesMedicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesEffective December 1, 2025
MedicaidAugust 12, 2025
Carelon Medical Benefits Management, Inc. updatesMedicaidAugust 7, 2025
You are invited: provider coding educationMedicare AdvantageAugust 1, 2025
Expanded specialty pharmacy precertification listCommercialAugust 1, 2025
SUD confidentiality protections for membersCommercialAugust 1, 2025
Support your patients with the CarelonRx, Inc. and Lark Weight Management ProgramCommercialMedicare AdvantageMedicaidAugust 1, 2025
You are invited: immunization measures webinarCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthMedicaidAugust 1, 2025
Updated provider manual is now availableCommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patientsCommercialAugust 1, 2025
Enhancing accuracy in evaluation and management services claimsCommercialAugust 1, 2025
Reminder: submitting facility claimsCommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicaidJuly 29, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
MedicaidJuly 28, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective October 29, 2025
Medicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialMedicare AdvantageMedicaidJuly 22, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 21, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideMedicaidJuly 18, 2025
Access free health education and interpreter servicesCommercialJuly 7, 2025
Direct HMO: PPO providers in an HMO networkCommercialMedicare AdvantageMedicaidJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataCommercialJuly 1, 2025
Claim editing update: Alignment with AMA CPT® guidelines for anatomical modifiersCommercialMedicare AdvantageMedicaidJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialJuly 1, 2025
Benefits of being a Direct HMO providerCommercialMedicare AdvantageMedicaidJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialMedicare AdvantageMedicaidJuly 1, 2025
Enhanced efficiency in dispute handlingCommercialJuly 1, 2025
Streamline BlueCard claims: Get the latest tips and best practicesCommercialJuly 1, 2025
Essential tips for accurate BlueCard claimsMedicaidJuly 1, 2025
Enhanced personalized match: improving the care provider search for membersMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingMedicare AdvantageJuly 1, 2025
A quick guide to understanding JW and JZ modifiersCommercialMedicare AdvantageMedicaidJuly 1, 2025
Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experienceCommercialMedicare AdvantageMedicaidJuly 1, 2025
Update: 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 26, 2025
Essential details on access to care surveys and our language assistance programMedicaidJune 26, 2025
Gender‑affirming careCommercialJune 25, 2025
Self‑Insured Schools of California benefit reminderMedicare AdvantageJune 23, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansMedicare AdvantageJune 17, 2025
2025 Medicare Advantage California EAE D‑SNP Fact SheetMedicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updates