Highlights

Key Updates

AdministrativeMedicaidNovember 21, 2024

Medicaid contract expiring after December 31, 2024

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 19, 2024

Roster Automation updates: roster download functionality

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 12, 2024

Roster automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 7, 2024

Time to prepare for HEDIS medical record review

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 7, 2024

Time to prepare for HEDIS medical record review

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidOctober 17, 2024

Maximizing care with regular provider data attestation

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder


What's New

Recent Updates

AdministrativeMedicaidNovember 21, 2024

Medicaid contract expiring after December 31, 2024

Policy UpdatesMedicaidNovember 21, 2024

Clinical Criteria update

Effective December 22, 2024

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 19, 2024

Roster Automation updates: roster download functionality

Products & Programs PharmacyCommercialNovember 18, 2024

Specialty pharmacy updates — December 2024

AdministrativeMedicare AdvantageNovember 18, 2024

Kentucky 2025 Medicare Advantage plan changes

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 12, 2024

Roster automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Quality ManagementMedicaidNovember 7, 2024

Provider: CAHPS awareness

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 7, 2024

Time to prepare for HEDIS medical record review

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 7, 2024

Time to prepare for HEDIS medical record review

Behavioral HealthCommercialNovember 1, 2024

Introducing a new Applied Behavior Analysis Provider Resource Guide

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageMedicaidNovember 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Policy Updates Reimbursement PoliciesMedicaidNovember 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

AdministrativeCommercialNovember 1, 2024

Personalized Match update

Quality ManagementCommercialMedicare AdvantageMedicaidNovember 1, 2024

HEDIS medical record submission made easier with our Remote EMR Access service

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy reminder: Multiple Surgery — Facility

Products & Programs Federal Employee Program (FEP)CommercialNovember 1, 2024

Submit corrected claims electronically for the Federal Employee Program®

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Quality ManagementMedicare AdvantageMedicaidOctober 29, 2024

HEDIS Measure Tips — Appropriate Treatment for Upper Respiratory Infection (URI) 2025

Products & Programs PharmacyCommercialOctober 24, 2024

Specialty pharmacy updates — November 2024

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 23, 2024

HEDIS Measure Tips — Appropriate Testing for Pharyngitis (CWP) 2025

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 22, 2024

HEDIS Measure Tips — Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidOctober 18, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective November 23, 2024

Education & TrainingCommercialMedicaidOctober 18, 2024

You are invited: Health Care Networks fall webinar

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidOctober 17, 2024

Maximizing care with regular provider data attestation

AdministrativeMedicaidOctober 16, 2024

External Independent Review (EIR) intake form

Administrative Digital SolutionsMedicare AdvantageMedicaidOctober 15, 2024

Use Availity Essentials to view authorization case status and set authorization decision notification preference

Administrative Digital SolutionsMedicare AdvantageMedicaidOctober 15, 2024

Expansion of digital-only authorization case status notifications

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder

AdministrativeMedicaidOctober 9, 2024

State communication: Telehealth reassessment (PL #A-273)

Quality ManagementCommercialMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

HEDIS Measure Tips — Adults’ Access to Preventive/Ambulatory Health Services (AAP) 2025

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

Products & Programs PharmacyCommercialOctober 1, 2024

Pharmacy information available on our provider website

AdministrativeCommercialOctober 1, 2024

National Accounts 2025 precertification list

Products & Programs PharmacyMedicare AdvantageOctober 1, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?