Key Updates
CommercialMedicare AdvantageJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
Recent Updates
CommercialMedicare AdvantageJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialJuly 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
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
Streamlining behavioral health authorizations via Availity EssentialsCommercialJuly 1, 2025
Reimbursement policy update: Nurse Practitioner and Physician Assistant servicesMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialMedicare AdvantageJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesCommercialMedicare AdvantageJuly 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
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
Collection of diversity and cultural competency training received in 2024CommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderCommercialJune 1, 2025
Material adverse change
Drug list updates — designated medical specialty pharmacyCommercialJune 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 typesCommercialMedicare AdvantageJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialJune 1, 2025
Update to claims system for global surgical procedures for professional providersCommercialMay 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
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalCommercialMedicare AdvantageApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics