Key Updates
CommercialMedicare AdvantageMedicaidAugust 1, 2025
You are invited: immunization measures webinar
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025
CommercialMedicare AdvantageMedicaidJuly 23, 2025
Enhance care provider data accuracy with updated roster tools
CommercialMedicare AdvantageMedicaidJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
Recent Updates
Medicare AdvantageAugust 1, 2025
Expanded specialty pharmacy precertification listCommercialAugust 1, 2025
SUD confidentiality protections for membersCommercialAugust 1, 2025
Support your patients with the CarelonRx, Inc. and Lark Weight Management ProgramCommercialMedicare AdvantageMedicaidAugust 1, 2025
You are invited: immunization measures webinarCommercialAugust 1, 2025
Facility diagnostic radiopharmaceuticals and contrast mediaMedicaidAugust 1, 2025
Upcoming changes to outpatient facility claims processingCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthCommercialMedicaidAugust 1, 2025
Dispute resolution process for care providersCommercialAugust 1, 2025
Upcoming updates: medical claims edit system for self‑administered drugsCommercialAugust 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 31, 2025
Carelon Medical Benefits Management, Inc. updatesEffective September 1, 2025
MedicaidJuly 29, 2025
Prior authorization requirement updated for procedure code H0038Medicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025Medicare AdvantageJuly 23, 2025
Carelon Medical Benefits Management, Inc. updatesEffective on October 1, 2025
CommercialMedicare AdvantageMedicaidJuly 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 AdvantageMedicaidJuly 18, 2025
New mandatory fields in roster templateMedicaidJuly 10, 2025
Quarterly pharmacy formulary change noticeCommercialMedicare AdvantageMedicaidJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersMedicare AdvantageJuly 1, 2025
A quick guide to understanding JW and JZ modifiersMedicaidJuly 1, 2025
Important information about utilization managementCommercialMedicare AdvantageMedicaidJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialMedicare AdvantageMedicaidJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsMedicaidJuly 1, 2025
Member Rights and Responsibilities section is online in the provider manualCommercialJuly 1, 2025
CMS drug fee schedule update effective August 1, 2025CommercialJuly 1, 2025
Update: essential ICD‑10‑CM compliance for outpatient facility claimsCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataCommercialMedicare AdvantageMedicaidJuly 1, 2025
Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experienceCommercialJuly 1, 2025
Reimbursement policy update: Bundled Services and Supplies — ProfessionalCommercialJuly 1, 2025
A quick guide to understanding JW and JZ modifiersMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingCommercialMedicare AdvantageMedicaidJuly 1, 2025
Update: National Drug Codes (NDCs) are required for professional and outpatient claimsMedicare AdvantageJune 27, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
Medicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expandedEffective November 1, 2025
Axtle, Bizengri, and Bynfezia pen
Medicare AdvantageJune 23, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansCommercialJune 23, 2025
Precertification/Prior Authorization list change notification July 1, 2025Medicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updatesCommercialMedicare AdvantageMedicaidJune 4, 2025
National Drug Codes (NDC) are required for outpatient claims