Highlights

Key Updates

Products & Programs PharmacyMedicaidFebruary 1, 2025

Partnership with Alto Pharmacy enhances prescription delivery services

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series


What's New

Recent Updates

Policy Updates Reimbursement PoliciesCommercialFebruary 1, 2025

New reimbursement policy: Place of Service — Professional

Products & Programs Federal Employee Program (FEP)CommercialFebruary 1, 2025

Corrected claim guidance for the Federal Employee Program®

AdministrativeCommercialMedicare AdvantageMedicaidFebruary 1, 2025

New Communication Center added to Availity Essentials

Education & TrainingCommercialMedicare AdvantageMedicaidFebruary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Products & Programs PharmacyCommercialFebruary 1, 2025

Pharmacy information available on our provider website

Quality ManagementCommercialMedicare AdvantageFebruary 1, 2025

2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyMedicaidFebruary 1, 2025

Partnership with Alto Pharmacy enhances prescription delivery services

Quality ManagementCommercialFebruary 1, 2025

Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)

Policy UpdatesMedicaidJanuary 31, 2025

Clinical Criteria updates

Effective March 7, 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Products & Programs PharmacyCommercialJanuary 27, 2025

Key formulary updates: effective January 1, 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 22, 2025

Breast Cancer Screening (BCS-E) 2025

Quality ManagementCommercialJanuary 22, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 21, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 21, 2025

Controlling High Blood Pressure (CBP)

Quality ManagementCommercialJanuary 17, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 16, 2025

Asthma Medication Ratio (AMR) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 16, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Products & Programs Federal Employee Program (FEP)CommercialJanuary 14, 2025

Authorization for post‑acute care services for FEP members

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 13, 2025

Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 13, 2025

Colorectal Cancer Screening (COL‑E) 2025

Quality ManagementMedicare AdvantageJanuary 13, 2025

Kidney Health Evaluation for Patients With Diabetes (KED) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 13, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 12, 2025

Medication Adherence 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 9, 2025

Advanced Illness and Frailty 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 9, 2025

Transition of Care (TRC) 2025

Quality ManagementMedicare AdvantageJanuary 8, 2025

Breast Cancer Screening (BCS-E) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 7, 2025

Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025

Products & Programs PharmacyMedicaidJanuary 6, 2025

Prior authorization updates for medications billed under the medical benefit

Effective March 1, 2025
Kisunla and Piasky

Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 6, 2025

Adult Immunization Status (AIS‑E) 2025

Quality Management Optimizing HEDIS & STARSCommercialJanuary 6, 2025

HEDIS Desktop Reference Guide for Commercial 2025

Products & Programs PharmacyMedicare AdvantageJanuary 1, 2025

Kroger Specialty Pharmacy acquisition

Products & Programs Federal Employee Program (FEP)CommercialJanuary 1, 2025

2025 FEHB and PSHB information available online

AdministrativeCommercialJanuary 1, 2025

Drug fee schedule update

AdministrativeMedicare AdvantageJanuary 1, 2025

Announcing Health Perks — earn rewards for your healthcare activities

AdministrativeCommercialMedicare AdvantageJanuary 1, 2025

New year, new labs: LabCorp and Quest Diagnostics now in‑network for Nevada plans

Products & Programs PharmacyMedicare AdvantageDecember 31, 2024

Important information about specialty prescriptions

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidDecember 30, 2024

Enhance patient coordination with Total Member View

Products & Programs PharmacyCommercialDecember 27, 2024

Weight management program overview

Quality ManagementCommercialDecember 26, 2024

HEDIS Well Child and Immunizations Coding Bulletin 2025

Administrative Digital SolutionsMedicaidDecember 24, 2024

Availity Essentials maternity update for providers

Education & TrainingCommercialMedicare AdvantageMedicaidDecember 24, 2024

Prefix required on claim submissions

Quality Management Optimizing HEDIS & STARSCommercialDecember 24, 2024

HEDIS® Category II Coding Bulletin 2025

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Effective March 1, 2025

Products & Programs PharmacyMedicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Effective April 1, 2025