Key Updates
CommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity Essentials
Recent Updates
Medicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsMedicaidApril 7, 2025
You are invited: provider coding educationMedicare AdvantageApril 2, 2025
HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025Medicare AdvantageApril 1, 2025
Carelon Medical Benefits Management, Inc. updatesEffective June 15, 2025
Medicare AdvantageApril 1, 2025
Carelon Medical Benefits Management, Inc. updatesEffective May 3, 2025
Medicare AdvantageApril 1, 2025
Carelon Medical Benefits Management, Inc. updatesEffective May 2, 2025
MedicaidApril 1, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 1, 2025
CommercialApril 1, 2025
Important CMS update: new average sales price fee schedule effective April 2025CommercialMedicare AdvantageMedicaidApril 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 — ProfessionalMedicaidMarch 28, 2025
InterQual March 2025 updatesCommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsCommercialMarch 27, 2025
Specialty pharmacy updates — April 2025Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMedicaidMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Medicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
MedicaidMarch 10, 2025
Project ECHO Nevada presents: Syphilis In Primary CareMedicaidMarch 4, 2025
Quarterly pharmacy formulary change noticeCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMedicare AdvantageMedicaidMarch 1, 2025
Reminder: provider data attestationCommercialMarch 1, 2025
Precertification list change notification March 1, 2025CommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewMedicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptionsEffective April 1, 2025
CommercialMedicare AdvantageMedicaidFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageMedicaidFebruary 28, 2025
Availity launches enhanced provider enrollment features for improved efficiencyMedicaidFebruary 25, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Orencia and Avsola
MedicaidFebruary 24, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Tevimbra and Tyenne
Medicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education creditsMedicaidFebruary 19, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Anktiva, Hercessi, and Imdelltra
CommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025