Key Updates
CommercialMedicare AdvantageMedicaidJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
Medicare AdvantageJune 17, 2025
2025 Medicare Advantage California EAE D‑SNP Fact Sheet
MedicaidJune 16, 2025
Timely access to care course and standards
Recent Updates
CommercialJuly 7, 2025
Direct HMO: PPO providers in an HMO networkCommercialMedicare AdvantageMedicaidJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersMedicare 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 experienceCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataMedicaidJuly 1, 2025
Enhanced personalized match: improving the care provider search for membersCommercialJuly 1, 2025
Essential tips for accurate BlueCard claimsCommercialJuly 1, 2025
Streamline BlueCard claims: Get the latest tips and best practicesCommercialMedicare AdvantageMedicaidJuly 1, 2025
Enhanced efficiency in dispute handlingCommercialMedicare AdvantageMedicaidJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialJuly 1, 2025
Benefits of being a Direct HMO providerMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialMedicare AdvantageMedicaidJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesCommercialJuly 1, 2025
Claim editing update: Alignment with AMA CPT® guidelines for anatomical modifiersCommercialMedicare AdvantageMedicaidJuly 1, 2025
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 updatesMedicaidJune 16, 2025
Policy update for transcranial magnetic stimulation codes — CPT 90867, 90868, 90869MedicaidJune 16, 2025
Timely access to care course and standardsMedicaidJune 10, 2025
Prior authorization updates for medications billed under the medical benefitMedicaidJune 5, 2025
Quality Incentive Program offerings for measurement year 2025CommercialMedicare AdvantageMedicaidJune 3, 2025
National Drug Codes (NDC) are required for outpatient claimsCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteMedicaidJune 1, 2025
Enhance patient care with our Complex Case Management programMedicaidJune 1, 2025
Member rights and responsibilities for care providersMedicaidJune 1, 2025
Essential UM guidelines for timely service preapproval and reimbursementCommercialJune 1, 2025
Direct HMO: understanding the network designMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialMedicare AdvantageMedicaidJune 1, 2025
Submitting BH authorizations in Availity EssentialsCommercialMedicare AdvantageMedicaidJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderMedicare 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