Highlights

Key Updates

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialMedicare AdvantageMedicaidMay 27, 2025

Boost your roster submission skills with Availity Essentials

Quality ManagementMedicaidMay 1, 2025

Join our medical committee to help shape healthcare innovations

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidMarch 1, 2025

Reminder: provider data attestation

What's New

Recent Updates

Policy UpdatesMedicaidMay 28, 2025

Clinical Criteria updates

Effective August 29, 2025

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialMedicare AdvantageMedicaidMay 27, 2025

Boost your roster submission skills with Availity Essentials

AdministrativeCommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Policy Updates Medical Policy & Clinical GuidelinesMedicaidMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 24, 2025

Products & Programs PharmacyMedicaidMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective September 1, 2025
Tevimbra and Tyenne

Policy UpdatesMedicaidMay 14, 2025

Carelon Medical Benefits Management, Inc. updates

Effective August 15, 2025

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidMay 1, 2025

Reminder: New Communication Center added to Availity Essentials

AdministrativeCommercialMay 1, 2025

Direct HMO: Understanding the network design

AdministrativeCommercialMay 1, 2025

Annual grievance and appeals attestation requirement

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Quality ManagementMedicaidMay 1, 2025

Join our medical committee to help shape healthcare innovations

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 30, 2025

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

Effective August 1, 2025

Education & TrainingMedicare AdvantageApril 29, 2025

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

AdministrativeCommercialMedicaidApril 29, 2025

Ensuring timely attention to expedited grievances and appeals

Policy UpdatesMedicaidApril 25, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 28, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidApril 21, 2025

2025 Clinical Practice Guidelines now available

Products & Programs Long-Term Services & SupportsMedicaidApril 18, 2025

Community-based adult services member ID prefix guidance

AdministrativeMedicaidApril 17, 2025

Improving maternal mental health: new screening protocols

Products & Programs PharmacyMedicare AdvantageApril 16, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

Products & Programs PharmacyMedicare AdvantageApril 16, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

Policy UpdatesMedicaidApril 9, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 10, 2025

Policy Updates Prior AuthorizationMedicaidApril 4, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Policy UpdatesMedicaidApril 3, 2025

Clinical Criteria updates

Effective July 7, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 1, 2025

Policy Updates Reimbursement PoliciesCommercialApril 1, 2025

Reimbursement policy updates for facilities

Education & TrainingCommercialMedicare AdvantageMedicaidApril 1, 2025

Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics

Policy Updates Prior AuthorizationMedicare AdvantageMarch 28, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Policy Updates Prior AuthorizationMedicare AdvantageMarch 26, 2025

Prior authorization requirement changes

Effective July 1, 2025

Policy UpdatesMedicaidMarch 21, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 30, 2025

Policy Updates Prior AuthorizationMedicaidMarch 20, 2025

Prior authorization requirement changes

Effective July 1, 2025

Products & Programs PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

AdministrativeCommercialMedicare AdvantageMedicaidMarch 19, 2025

Technical difficulties: My Diverse Patients

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Policy Updates Prior AuthorizationMedicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Products & Programs PharmacyMedicare AdvantageMarch 3, 2025

Important change to your patients’ specialty prescriptions

AdministrativeCommercialMarch 1, 2025

Practices improve patient access using NPs and PAs

Policy Updates Medical Policy & Clinical GuidelinesMedicaidMarch 1, 2025

Update to Clinical Practice Guidelines

AdministrativeCommercialMarch 1, 2025

Direct HMO now serving southern California counties

Products & Programs Federal Employee Program (FEP)CommercialMarch 1, 2025

Changes in Postal Service Health Benefits for 2025