Highlights

Key Updates

Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 7, 2025

Best practices for managing provider referrals in the Care Central referrals dashboard

Policy UpdatesCommercialJune 13, 2025

Streamlined claim submission process update


What's New

Recent Updates

Products & Programs Long-Term Services & SupportsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 8, 2025

The Provider Satisfaction Survey — Your opinion matters

Products & Programs Long-Term Services & SupportsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 7, 2025

Provider Satisfaction Survey reminder

Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 7, 2025

Best practices for managing provider referrals in the Care Central referrals dashboard

Products & Programs Long-Term Services & SupportsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 2, 2025

LTSS Provider Quality Incentive Programs overview

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

Change to Prior Authorization Requirements

New reimbursement policy: Code and Clinical Editing Guidelines — Professional and Facility

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

Change to Prior Authorization Requirements

Reimbursement policy update: Bundled Services and Supplies — Professional

AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

AdministrativeCommercialJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

Administrative Digital SolutionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 1, 2025

Streamlining behavioral health authorizations via Availity Essentials

AdministrativeMedicare AdvantageJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

AdministrativeCommercialJuly 1, 2025

Enroll with Availity to verify your provider data

AdministrativeCommercialMedicare AdvantageJuly 1, 2025

Provider manual update effective August 2025

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 1, 2025

Earn CME credits: Attend our engaging webinars

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 1, 2025

Simplify care with our Complex Care Management program

Education & TrainingMedicare AdvantageJuly 1, 2025

Combat diabetes: Close the statin therapy gap for better heart health

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 1, 2025

UM guidelines for timely service preapproval and reimbursement

Products & ProgramsHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 1, 2025

New incentive program — smoking cessation

Products & Programs PharmacyCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 27, 2025

National Drug Codes (NDC) Are Required for Outpatient Claims

Products & Programs PharmacyMedicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

Effective November 1, 2025
Axtle, Bizengri, and Bynfezia pen

Policy Updates Prior AuthorizationCommercialJune 25, 2025

Provider specialty and subspecialty designations for utilization management

Policy Updates Medical Policy & Clinical GuidelinesCommercialJune 25, 2025

Change to Prior Authorization Requirements

Medical Policies and Clinical Guidelines updates — August 2025

Administrative Digital SolutionsMedicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Policy UpdatesCommercialJune 13, 2025

Streamlined claim submission process update

Education & TrainingCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 4, 2025

Boost your roster submission skills with Availity Essentials

Policy Updates Prior AuthorizationMedicare AdvantageJune 3, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025

Products & Programs PharmacyHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 3, 2025

Prior authorization updates for medications billed under the medical benefit

Effective September 1, 2025
Tevimbra

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyCommercialJune 2, 2025

Change to Prior Authorization Requirements

Specialty pharmacy updates: June 2025

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 1, 2025

Provider Pathways: your personalized learning platform

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

AdministrativeMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 1, 2025

Additional drug codes added to medical claims edit system

Products & Programs PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 1, 2025

Clarifying roles in healthcare: member rights and responsibilities

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Administrative Digital SolutionsCommercialMedicare AdvantageHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJune 1, 2025

Submitting BH authorizations in Availity Essentials

Education & Training WebinarsCommercialMedicare AdvantageJune 1, 2025

Registration is now available for our upcoming CME webinar on Integrating Cancer Care

Products & Programs PharmacyCommercialMay 30, 2025

Key updates to the Designated Medical Specialty Pharmacy Drug List

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

AdministrativeCommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Education & TrainingHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingMay 22, 2025

You are invited: Indiana PathWays for Aging training

Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingMay 21, 2025

Updated Clinical Practice Guidelines now available

Products & Programs PharmacyHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingMay 20, 2025

New preapproval requirements for Givlaari

Effective August 1, 2025

Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingMay 14, 2025

Announcement: Temporary Emergency Financial Assistance Payment Reconciliation

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025