Key Updates
CommercialJune 1, 2025
Availity Essentials Provider Overpayments application launch
Medicare AdvantageJune 1, 2025
Medicare preferred continuous glucose monitors
CommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminder
CommercialMedicare AdvantageMedicaidMay 27, 2025
Boost your roster submission skills with Availity Essentials
MedicaidMay 22, 2025
Provider manual updates for Nevada Medicaid
CommercialMedicare AdvantageMedicaidMarch 1, 2025
Reminder: provider data attestation
Recent Updates
CommercialJune 1, 2025
Medical Policies and Clinical Utilization Management Guidelines are now availableCommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderMedicare AdvantageJune 1, 2025
Medicare preferred continuous glucose monitorsCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launchMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialMedicare AdvantageMedicaidJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareMedicaidJune 1, 2025
Enhance patient care with our Complex Care Management programCommercialMedicare AdvantageMedicaidJune 1, 2025
Submitting BH authorizations in Availity EssentialsMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialJune 1, 2025
Update to claims system for global surgical proceduresMedicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMedicare AdvantageMedicaidMay 27, 2025
Boost your roster submission skills with Availity EssentialsMedicaidMay 26, 2025
2025 Clinical Practice GuidelinesMedicaidMay 22, 2025
Provider manual updates for Nevada MedicaidCommercialMay 22, 2025
Action required: annual patient safety attestationMedicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
MedicaidMay 20, 2025
Prior authorization updates for medications billed under the medical benefitEffective July 1, 2025
Ahzantive, Enzeevu, Opuviz, Pavblu, and Yesafili
MedicaidMay 15, 2025
Prior authorization updates for medications billed under the medical benefitEffective July 1, 2025
Jubbonti; Wyost, Nemluvio, Nypozi, Rytelo, Tecelra, and Yimmugo
MedicaidMay 13, 2025
You are invited: Medicaid provider orientationMedicaidMay 1, 2025
Quarterly pharmacy formulary change noticeCommercialMedicare AdvantageMedicaidMay 1, 2025
Welcome to West Henderson HospitalMedicaidMay 1, 2025
Enhancing your learning experience: latest updates in Provider PathwaysMedicare AdvantageMedicaidMay 1, 2025
Additional drug codes added to medical claims edit systemCommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsCommercialMedicare AdvantageApril 30, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective August 1, 2025
MedicaidApril 29, 2025
New preapproval rules for medicationsEffective June 1, 2025
Ebglyss, Lymphir, Niktimvo, and Ocrevus Zunovo
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 25, 2025
Medicare AdvantageApril 18, 2025
New specialty pharmacy medical step therapy requirementEffective June 1, 2025
Hercessi
Medicare AdvantageApril 18, 2025
Specialty pharmacy preapproval list updateEffective August 1, 2025
Jubbonti; Wyost
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 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 Essentials