Highlights

Key Updates

Policy Updates Prior AuthorizationCommercialMedicare AdvantageMedicaidJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers


What's New

Recent Updates

Policy UpdatesMedicaidJuly 1, 2025

Clinical Criteria updates

Effective August 3, 2025

Policy Updates Prior AuthorizationCommercialMedicare AdvantageMedicaidJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

New reimbursement policy: Code and Clinical Editing Guidelines — Professional and Facility

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

Reimbursement policy update: Bundled Services and Supplies — Professional

AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

AdministrativeCommercialJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

AdministrativeMedicare AdvantageJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidJuly 1, 2025

Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experience

AdministrativeCommercialJuly 1, 2025

Enroll with Availity to verify your provider data

AdministrativeCommercialJuly 1, 2025

CMS drug fee schedule update effective August 1, 2025

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidJuly 1, 2025

Streamlining behavioral health authorizations via Availity Essentials

Education & TrainingMedicare AdvantageJuly 1, 2025

Combat diabetes: Close the statin therapy gap for better heart health

Quality ManagementMedicaidJuly 1, 2025

Important information about utilization management

Education & Training WebinarsCommercialMedicare AdvantageMedicaidJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyCommercialMedicare AdvantageMedicaidJuly 1, 2025

National Drug Codes (NDCs) are required for professional and outpatient claims

Policy Updates Prior AuthorizationMedicare AdvantageJune 27, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025

Education & TrainingMedicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

Policy Updates Prior AuthorizationCommercialJune 23, 2025

Precertification/Prior Authorization list change notification July 1, 2025

Administrative Digital SolutionsMedicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Policy Updates Prior AuthorizationMedicaidJune 13, 2025

Prior authorization requirement changes

Effective August 1, 2025

Policy UpdatesMedicaidJune 9, 2025

Clinical Criteria updates

Effective July 11, 2025

Products & Programs PharmacyCommercialMedicare AdvantageMedicaidJune 4, 2025

National Drug Codes (NDC) are required for outpatient claims

Policy Updates Medical Policy & Clinical GuidelinesMedicaidJune 3, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective July 9, 2025

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyCommercialJune 2, 2025

Specialty pharmacy updates: June 2025

Policy Updates Medical Policy & Clinical GuidelinesCommercialJune 1, 2025

Medical Policies and Clinical Utilization Management Guidelines are now available

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidJune 1, 2025

Submitting BH authorizations in Availity Essentials

Quality ManagementMedicaidJune 1, 2025

Enhance patient care with our Complex Care Management program

Education & Training WebinarsCommercialMedicare AdvantageMedicaidJune 1, 2025

Registration is now available for our upcoming CME webinar on Integrating Cancer Care

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Products & Programs PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialMedicare AdvantageMedicaidMay 27, 2025

Boost your roster submission skills with Availity Essentials

Policy Updates Medical Policy & Clinical GuidelinesMedicaidMay 26, 2025

2025 Clinical Practice Guidelines

Education & TrainingMedicaidMay 22, 2025

Provider manual updates for Nevada Medicaid

AdministrativeCommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Products & Programs PharmacyMedicaidMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Ahzantive, Enzeevu, Opuviz, Pavblu, and Yesafili

Products & Programs PharmacyMedicaidMay 15, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Jubbonti; Wyost, Nemluvio, Nypozi, Rytelo, Tecelra, and Yimmugo

Policy UpdatesMedicaidMay 14, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 20, 2025

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

Education & TrainingMedicaidMay 13, 2025

You are invited: Medicaid provider orientation

Products & Programs PharmacyMedicaidMay 1, 2025

Quarterly pharmacy formulary change notice