Highlights

Key Updates

Education & Training WebinarsCommercialMedicare AdvantageAugust 1, 2025

You are invited: immunization measures webinar

Products & Programs PharmacyCommercialJuly 24, 2025

Specialty pharmacy updates — August 2025

AdministrativeCommercialMedicare AdvantageJuly 23, 2025

Enhance care provider data accuracy with updated roster tools

Policy Updates Prior AuthorizationCommercialMedicare AdvantageJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers


What's New

Recent Updates

Products & Programs PharmacyMedicare AdvantageAugust 1, 2025

Expanded specialty pharmacy precertification list

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

Changes to Federal Employees Health Benefits program and Postal Service Health Benefits program telemedicine services

AdministrativeCommercialAugust 1, 2025

SUD confidentiality protections for members

Education & Training WebinarsCommercialMedicare AdvantageAugust 1, 2025

You are invited: immunization measures webinar

AdministrativeCommercialAugust 1, 2025

Facility diagnostic radiopharmaceuticals and contrast media

Quality ManagementCommercialMedicare AdvantageAugust 1, 2025

Compatibility in care: sharing REL data to improve member health

Policy Updates Medical Policy & Clinical GuidelinesCommercialAugust 1, 2025

Medical Policy and Clinical Guideline updates

Effective November 1, 2025

Behavioral HealthCommercialAugust 1, 2025

Introducing a new Applied Behavior Analysis Provider Resource Guide

Products & Programs PharmacyCommercialAugust 1, 2025

Clinical Criteria updates for specialty pharmacy

Effective November 1, 2025

Policy UpdatesMedicare AdvantageJuly 28, 2025

Clinical Criteria updates

Effective September 4, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageJuly 25, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 28, 2025

Products & Programs PharmacyCommercialJuly 24, 2025

Specialty pharmacy updates — August 2025

AdministrativeCommercialMedicare AdvantageJuly 23, 2025

Enhance care provider data accuracy with updated roster tools

Products & Programs PharmacyCommercialJuly 22, 2025

July formulary deletions

AdministrativeMedicare AdvantageJuly 21, 2025

Anthem Medicare Advantage Group Retiree Quick Reference Guide

Education & TrainingCommercialMedicare AdvantageJuly 18, 2025

New mandatory fields in roster template

Policy Updates Prior AuthorizationCommercialMedicare AdvantageJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Education & Training WebinarsCommercialMedicare AdvantageJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

Education & TrainingMedicare AdvantageJuly 1, 2025

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

Administrative Digital SolutionsCommercialMedicare AdvantageJuly 1, 2025

Streamlining behavioral health authorizations via Availity Essentials

Policy Updates Medical Policy & Clinical GuidelinesCommercialJuly 1, 2025

Medical Policy and Clinical Guideline updates

Policy Updates Prior AuthorizationCommercialJuly 1, 2025

Precertification/Prior Authorization list change notification July 1, 2025

AdministrativeCommercialJuly 1, 2025

Enroll with Availity to verify your provider data

Administrative Digital SolutionsCommercialMedicare AdvantageJuly 1, 2025

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

AdministrativeCommercialJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

Reimbursement policy update: Bundled Services and Supplies — Professional

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

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

AdministrativeMedicare AdvantageJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

Products & Programs PharmacyCommercialMedicare AdvantageJuly 1, 2025

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

Products & Programs PharmacyMedicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

Effective November 1, 2025
Axtle, Bizengri, and Bynfezia pen

Administrative Digital SolutionsMedicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Products & Programs PharmacyCommercialMedicare AdvantageJune 6, 2025

National Drug Codes (NDCs) are required for outpatient claims

Policy Updates Prior AuthorizationMedicare AdvantageJune 3, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyCommercialJune 2, 2025

Specialty pharmacy updates: June 2025

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Products & Programs PharmacyCommercialJune 1, 2025

Clinical Criteria updates for specialty pharmacy

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Administrative Digital SolutionsCommercialMedicare AdvantageJune 1, 2025

Submitting BH authorizations in Availity Essentials

Education & Training WebinarsCommercialMedicare AdvantageJune 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

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder