Key Updates
CommercialMedicare AdvantageMay 27, 2025
Boost your roster submission skills with Availity Essentials
CommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestation
Recent Updates
CommercialMay 28, 2025
Material adverse change
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesMedicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMedicare AdvantageMay 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
CommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsMedicare AdvantageMay 1, 2025
Additional drug codes added to medical claims edit systemMedicare AdvantageApril 30, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective August 1, 2025
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 25, 2025
Medicare AdvantageApril 18, 2025
New specialty pharmacy medical step therapy requirementEffective June 1, 2025
Hercessi
Medicare AdvantageApril 18, 2025
Specialty pharmacy preapproval list updateEffective August 1, 2025
Jubbonti; Wyost
Medicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsCommercialApril 1, 2025
Important CMS update: new average sales price fee schedule effective April 2025CommercialMedicare AdvantageApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalCommercialApril 1, 2025
Material adverse change
Precertification list change notification April 1, 2025CommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsMedicare AdvantageMarch 27, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
CommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 1, 2025
Material adverse change
Precertification list change notification March 1, 2025CommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestationMedicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptionsEffective April 1, 2025
CommercialMedicare AdvantageFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageFebruary 28, 2025
Update: 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 — FacilityCommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 4, 2025
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialFebruary 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 websiteCommercialMedicare AdvantageFebruary 1, 2025
New Communication Center added to Availity Essentials