Highlights

Key Updates

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 14, 2024

Maximizing care with regular provider data attestation

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 25, 2024

Time to prepare for HEDIS medical record review

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder


What's New

Recent Updates

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Policy Updates Prior AuthorizationMedicaidNovember 21, 2024

Prior authorization requirement changes

Effective December 22, 2024

AdministrativeMedicare AdvantageNovember 18, 2024

Nevada 2025 Medicare Advantage plan changes

Products & Programs PharmacyCommercialNovember 18, 2024

Material adverse change

Specialty pharmacy updates — December 2024

Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

AdministrativeMedicare AdvantageNovember 15, 2024

Skilled nursing facility — vaccine serum compensation

Policy UpdatesMedicaidNovember 15, 2024

Carelon Medical Benefits Management, Inc. updates

Effective December 18, 2024

Policy UpdatesMedicaidNovember 15, 2024

Clinical Criteria updates

Effective December 18, 2024

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 14, 2024

Maximizing care with regular provider data attestation

Administrative Digital SolutionsMedicaidNovember 14, 2024

Advancing digital efficiency by discontinuing paper remittances

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?

Policy Updates Medical Policy & Clinical GuidelinesMedicaidNovember 14, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective December 15, 2024

Behavioral HealthMedicaidNovember 11, 2024

Nevada expanded applied behavioral analysis services to all ages

Policy UpdatesMedicaidNovember 7, 2024

Clinical Criteria update

Effective December 11, 2024

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Material adverse change

Precertification List Change Notification — November 1, 2024

Codes J3393 and J3394

AdministrativeCommercialNovember 1, 2024

Personalized Match update

Products & Programs PharmacyMedicare AdvantageNovember 1, 2024

Improving patient outcomes: back to the basics

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Material adverse change

Precertification List Change Notification — November 1, 2024

Administrative Digital SolutionsCommercialNovember 1, 2024

Adopting digital member ID cards

Administrative Digital SolutionsMedicaidNovember 1, 2024

Enhanced personalized match: making the care provider search more informed and personalized

Behavioral HealthCommercialNovember 1, 2024

Introducing a new Applied Behavior Analysis Provider Resource Guide

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

Quality ManagementMedicare AdvantageMedicaidOctober 29, 2024

HEDIS Measure Tips — Appropriate Treatment for Upper Respiratory Infection (URI) 2025

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 25, 2024

Time to prepare for HEDIS medical record review

Products & Programs PharmacyCommercialOctober 24, 2024

Material adverse change

Specialty pharmacy updates — November 2024

Quality ManagementMedicaidOctober 24, 2024

Provider: CAHPS awareness

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 23, 2024

HEDIS Measure Tips — Appropriate Testing for Pharyngitis (CWP) 2025

AdministrativeCommercialOctober 23, 2024

Do you offer telehealth services? Let us know!

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 22, 2024

HEDIS Measure Tips — Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) 2025

Education & TrainingMedicare AdvantageOctober 15, 2024

Model of Care training reminder

Policy Updates Medical Policy & Clinical GuidelinesMedicaidOctober 11, 2024

Billing guidelines for outpatient observation: 48-hour rule

Policy Updates Prior AuthorizationMedicaidOctober 10, 2024

Prior authorization requirement changes

Effective December 1, 2024

Products & Programs PharmacyMedicaidOctober 8, 2024

Prior authorization updates for medications billed under the medical benefit

Effective December 1, 2024
Amtagvi, iDoseTR, and Nexobrid

AdministrativeMedicaidOctober 8, 2024

PCP changes now available in Availity Essentials

Quality ManagementCommercialMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Products & Programs PharmacyMedicaidOctober 4, 2024

Prior authorization updates for medications billed under the medical benefit

Effective December 1, 2024
Alyglo, Simlandi, and Winrevair

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

HEDIS Measure Tips — Adults’ Access to Preventive/Ambulatory Health Services (AAP) 2025

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

Policy UpdatesMedicaidOctober 3, 2024

Clinical Criteria updates

Effective November 4, 2024

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025