At a glance:

• Care providers contracted with us need to verify and update their demographic data every 90 days using the provider data management (PDM) feature in Availity Essentials.
• Updating and attesting data are critical for maintaining accurate service directories for members and noncompliance with these requirements can result in removal from the online provider directory.
• Availity Essentials provides digital applications that enable users to monitor submitted demographic updates in real time, review the history of previously verified data, and manage multiple updates within one spreadsheet via the Upload Roster feature.

What are the requirements for the attestation of demographic data?

We require our contracted care provider partners to attest to their demographic data every 90 days. Maintaining your provider data is critical as it results in improved connection to members seeking care, supports the accuracy of claims processing, and allows for timely reimbursement, while aligning to a bold purpose of improving the health of humanity.

How do I update and attest to my data?

We require the use of the PDM capability available on Availity Essentials to update your provider or facility data. There are two options within Availity Essentials PDM that are available at no cost to care providers:

• Multipayer platform, which includes Directory Verification and Core PDM: allows care providers to make required updates using Directory Verification and changes using Core PDM
• Roster upload: allows care providers to submit multiple updates within one spreadsheet via the Upload Roster feature (The Upload Roster feature is currently only available and shared with the health plan.)

Both the multipayer platform and Roster Upload feature satisfy your 90‑day attestation requirement.

To attest to your provider data:

1. Log in to https://Availity.com.
2. Navigate to My Providers > Provider Data Management.
3. Select the action menu next to the business whose information you want to verify.
4. Select Verify Directory Listing.
5. Review each set of data for accuracy.
6. Once complete, select Submit Verified Profile.

Organizations with no changes since their last submission may see a Quick Verify button that allows for directory verification in one click.

Individuals registered for their TIN within the Availity Manage My Organization application on Availity Essentials will receive periodic automated emails and notifications in the Notification Center on Availity Essentials reminding them when their attestation is due or overdue.

How do I access Availity Essentials and the PDM application?

To access the PDM application, log on to https://Availity.com and select My Providers > Provider Data Management to begin using PDM. Administrators will automatically be granted access to PDM. Additional staff may be given access to PDM by an administrator. To find your administrator, go to My Account Dashboard > My Account > Organization(s) > Administrator Information.

Within PDM you also have the ability to:

• Monitor submitted demographic updates in real time with a digital dashboard.
• Review the history of previously verified data.

Why is updating and attesting to my data important?

Our members use Find Care to make informed decisions about their healthcare and find quality doctors and hospitals. Keeping your data up to date ensures members have access to you when they need it the most.

Failure to complete the 90‑day attestation requirement puts your organization at risk of being classified as non‑compliant with the health plan’s policies and procedures and may result in removal from the online provider directory.

What if I’m not registered for Availity Essentials yet?

If you aren’t registered to use Availity Essentials, signing up is easy and secure. There is no cost to register or to use any of the digital applications. Start by going to https://Availity.com and selecting New to Availity? Get Started at the top of the home screen to access the registration page. If you have more than one TIN, ensure you have registered all TINs associated with your account.

If you have questions regarding registration, reach out to Availity Client Services at 800‑AVAILITY (282‑4548).

How do I get training on the Availity Essentials PDM tool?

You can learn about and attend one of our training opportunities by visiting here (apps.availity.com):

• For more information on PDM, check out the Quick Start Guide here (apps.availity.com) using your Availity Essentials user ID and password.
• For more information about the Roster Upload process:
  • See the Roster Submission Guide on https://Availity.com > Payer Spaces > Select Payer Tile > Resources > Roster Submission Guide using PDM.
  • Find training specifically for the Standard Template and Rules of Engagement by listening to our recorded webinar on our provider Learning Hub.
  • Take an on‑demand class hosted by Availity Essentials on the Learning Hub to learn about PDM.

What if I’m a behavioral health care provider?

If you are a behavioral health care provider and assigned to Carelon Behavioral Health, Inc., follow the Carelon Behavioral Health process for attestation. Council for Affordable Quality Healthcare (CAQH) care providers should attest, confirm, or update their data through the CAQH website. Non‑CAQH care providers and facilities should attest, confirm, or update their data directly with Carelon Behavioral Health.

Contact us

Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to https://Availity.com and select the appropriate payer space tile from the drop‑down. Then, select Chat with Payer and complete the pre‑chat form to start your chat.

For additional support, visit the Contact Us section of our provider website for the appropriate contact.

By the end of the Summer 2025, you will be able to submit all your authorizations in one application on https://Availity.com.

You may already be submitting your physical health authorizations through the Availity Essentials multi‑payer Authorization application — taking advantage of the time savings and speed to care through digital authorization submissions. You will soon be able to submit both your physical health and behavioral health (BH) authorizations through one Authorization application on https://Availity.com.

Using the Authorization application to submit your BH authorizations will not be much different from the process you follow today. You may enjoy more intuitive screens or learn sooner if an authorization is required, but the digital submission process is still the best way to submit your authorization requests and the fastest way to care for our members.

You will continue to use Interactive Care Reviewer (ICR) to submit an appeal or authorization for medical specialty prescriptions.

Accessing the Authorization application is easy. Ask your organization’s Availity administrator to ensure you have the Authorization role assignment. Without the role assignment, you will not be able to access the Authorization application. Then, log on to https://Availity.com to access the app through the Patient Registration tab by selecting Authorizations and Referrals.

Training is available

Training is available for the Authorization application. Once registered with the authorization role assignment, visit the training site to enroll for an upcoming live webcast or to access an on‑demand recording at the Authorization Training Site.

We are focused on reducing administrative burdens, so you can do what you do best — care for our members.

Please join us on June 10, 2025, for our upcoming CME webinar with Dr. Sarah Temkin from the American Cancer Society (ACS).

Dr. Temkin will discuss current trends in breast and colorectal cancer incidence and mortality, the role of primary care in enhancing cancer outcomes, and the ACS's resources for optimal cancer care. The key measures that will be highlighted are Breast Cancer Screening and Colorectal Cancer Screening (ECDS).

Register now by visiting this link:

• Title: Integrating Cancer Care: Enhancing Prevention, Early Detection, and More in Primary Care
• Date: Tuesday, June 10, 2025
• Time: Noon ET

This session is approved for one AAFP credit.
The registration page opens best in the Google Chrome browser.

We ask care providers to periodically review the pharmacy information available on our provider website for new or updated information. Staying updated on changes gives our members the best access to the highest quality care. Visit anthem.com/pharmacy-information for more information about:

• Copay or coinsurance requirements and their applicable drug classes.
• Drug lists and changes.
• Preapproval criteria.
• Procedures for generic substitution.
• Therapeutic interchange.
• Step therapy or other management methods subject to prescribing decisions.
• Other requirements, restrictions, or limitations for using certain drugs.

The commercial and exchange drug lists are posted to the website quarterly on the first day of the month in January, April, July, and October.

Visit carelonrx.com/solutions/providers for information on submitting a preapproval request or an exception request for a drug not on a drug list.

Federal Employee Program pharmacy updates and other pharmacy‑related information can be accessed at fepblue.org > Pharmacy Benefits.

If you do not have internet access, contact Provider Services via the number on the back of our member ID card to request a copy of the pharmaceutical information available online.

Starting July 1, 2025, the following Part B medications from the current Clinical Criteria Guidelines will be included in our medical step therapy precertification review process.

Step therapy will apply to members upon precertification initiation in addition to the current medical necessity review.

Step therapy will not apply to members actively receiving the medications listed below.

Clinical Criteria Guidelines are publicly available at https://anthem.com/provider/medicare‑advantage. Visit the Clinical Criteria page to search for specific criteria.