Key Updates
CommercialMedicare AdvantageAugust 1, 2025
You are invited: immunization measures webinar
CommercialMedicare AdvantageJuly 23, 2025
Enhance care provider data accuracy with updated roster tools
Recent Updates
CommercialAugust 14, 2025
Material adverse change
Carelon Medical Benefits Management, Inc. Additional Outpatient Utilization Management and SurgicalMedicare AdvantageAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesCommercialAugust 14, 2025
Material adverse change
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesMedicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesEffective December 1, 2025
Medicare AdvantageAugust 12, 2025
Precertification/prior authorization requirement changesMedicare 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 AdvantageAugust 1, 2025
You are invited: immunization measures webinarCommercialAugust 1, 2025
Material adverse change
Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and Facility updateCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthCommercialAugust 1, 2025
Upcoming updates: medical claims edit system for self‑administered drugsCommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patientsCommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialMedicare AdvantageJuly 23, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 22, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideCommercialMedicare AdvantageJuly 18, 2025
New mandatory fields in roster templateCommercialMedicare AdvantageJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialMedicare AdvantageJuly 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
Material adverse change
New reimbursement policy: Code and Clinical Editing Guidelines – Professional and FacilityCommercialJuly 1, 2025
Material adverse change
Reimbursement policy update: Bundled Services and Supplies – ProfessionalMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingCommercialJuly 1, 2025
A quick guide to understanding JW and JZ modifiersMedicare AdvantageJuly 1, 2025
A quick guide to understanding JW and JZ modifiersCommercialMedicare AdvantageJuly 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 dataCommercialJuly 1, 2025
Material adverse change
Precertification/prior authorization list change notification July 1, 2025CommercialJuly 1, 2025
Reimbursement policy update: Nurse Practitioner and Physician Assistant servicesCommercialMedicare AdvantageJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialJuly 1, 2025
Update: essential ICD‑10‑CM compliance for outpatient facility claimsCommercialJuly 1, 2025
Readmission review process changeCommercialJuly 1, 2025
CMS drug fee schedule update effective August 1, 2025CommercialMedicare AdvantageJuly 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
Medicare AdvantageJune 23, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansMedicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updatesCommercialMedicare AdvantageJune 6, 2025
National Drug Codes (NDCs) are required for outpatient claimsCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launchMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill types