Key Updates
CommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestation
Recent Updates
CommercialMay 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 systemCommercialMedicare 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 July 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 SolutionsMedicare AdvantageApril 4, 2025
Professional provider fee schedule notificationCommercialMedicare 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 — ProfessionalCommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsCommercialMarch 27, 2025
Specialty pharmacy updates — April 2025Medicare 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 June 12, 2025
CommercialMarch 1, 2025
Precertification list change notification March 1, 2025CommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMedicare 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
Update: Availity launches enhanced provider enrollment features for improved efficiencyCommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 4, 2025
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Medical records needed for accurate payment of certain facility inpatient claimsCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialFebruary 1, 2025
Clinical Criteria updates for specialty pharmacyCommercialMedicare AdvantageFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 14, 2025
Authorization for post‑acute care services for FEP membersCommercialMedicare AdvantageJanuary 1, 2025
Enhance billing and coding accuracy with new Payment Integrity training