Key Updates
Medicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploads
CommercialMedicare AdvantageAugust 25, 2025
Enhance your skills with expanded billing and coding training
Recent Updates
CommercialSeptember 1, 2025
Specialty pharmacy updates — September 2025Medicare AdvantageSeptember 1, 2025
Medication safety: Reducing risks with thoughtful prescribing and monitoringMedicare AdvantageSeptember 1, 2025
Elevate your workflow with seamless patient chart uploadsMedicare AdvantageSeptember 1, 2025
Elevate your practice efficiency with electronic prescriber toolsCommercialAugust 26, 2025
New guidelines for PET radiotracer management in UM beginning December 1, 2025CommercialAugust 26, 2025
Carelon Medical Benefits Management, Inc. Additional Outpatient Utilization Management and SurgicalCommercialMedicare AdvantageAugust 25, 2025
Enhance your skills with expanded billing and coding trainingMedicare AdvantageAugust 25, 2025
Anthem expands specialty pharmacy precertification listsEffective December 1, 2025
Avtozma, Osenvelt, Osenvelt, Stoboclo, and Xbryk
Medicare AdvantageAugust 21, 2025
Medication safety: Clinical strategies for EMR monitoring and preventionMedicare AdvantageAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective November 15, 2025
CommercialAugust 14, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective November 15, 2025
Medicare AdvantageAugust 14, 2025
Precertification/prior authorization requirement changesEffective December 1, 2025
Medicare AdvantageAugust 1, 2025
Expanded specialty pharmacy precertification listEffective November 1, 2025
Bomyntra, Conexxence, Imaav, Jobevne, Omlyclo, Qfitlia, Vyalev, and Jobevne
CommercialAugust 1, 2025
SUD confidentiality protections for membersCommercialAugust 1, 2025
Support your patients with the CarelonRx, Inc. and Lark Weight Management ProgramCommercialMedicare AdvantageAugust 1, 2025
You are invited: immunization measures webinarCommercialAugust 1, 2025
Stay informed: upcoming provider manual updates for enhanced partnershipCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthCommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patientsCommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025CommercialMedicare AdvantageJuly 23, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 22, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideCommercialMedicare AdvantageJuly 18, 2025
New mandatory fields in roster templateCommercialMedicare AdvantageJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialMedicare AdvantageJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialJuly 1, 2025
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 experienceCommercialMedicare AdvantageJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataCommercialMedicare AdvantageJuly 1, 2025
Electronic payments starting in October 2025CommercialMedicare AdvantageJuly 1, 2025
Electronic payments and Explanation of Payment starting in mid‑OctoberCommercialMedicare AdvantageJuly 1, 2025
Update: 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
CommercialJune 25, 2025
Medical Policies and Clinical Guidelines updates — August 2025Medicare 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 claimsMedicare AdvantageJune 3, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
CommercialJune 2, 2025
Specialty pharmacy updates: June 2025