Key Updates
CommercialMedicare AdvantageMarch 19, 2025
Technical difficulties: My Diverse Patients
Medicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptions
CommercialMedicare AdvantageFebruary 28, 2025
Availity launches enhanced provider enrollment features for improved efficiency
Recent Updates
Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Medicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
CommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestationCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Material adverse change
Precertification list change notification March 1, 2025CommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025Medicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptionsCommercialMedicare AdvantageFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageFebruary 28, 2025
Availity launches enhanced provider enrollment features for improved efficiencyCommercialFebruary 25, 2025
Material adverse change
New reimbursement policy: Emergency Department: Leveling of Evaluation and Management Services — FacilityMedicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education creditsCommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025CommercialFebruary 10, 2025
Colorectal Cancer Screening (COL-E) 2025CommercialFebruary 4, 2025
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)CommercialFebruary 1, 2025
Material adverse change
Reimbursement policy update: Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and FacilityCommercialFebruary 1, 2025
Designated specialty pharmacy network updatesCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Material adverse change
Medical records needed for accurate payment of certain facility inpatient claimsCommercialMedicare AdvantageFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialJanuary 30, 2025
CMS reveals 2025 Q1 drug pricing: key changes effective February 1stMedicare AdvantageJanuary 28, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025CommercialJanuary 22, 2025
Breast Cancer Screening (BCS-E) 2025CommercialJanuary 22, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025CommercialJanuary 21, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 21, 2025
Controlling High Blood Pressure (CBP)CommercialJanuary 17, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 16, 2025
Asthma Medication Ratio (AMR) 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 16, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025