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 AdvantageMay 27, 2025
Boost your roster submission skills with Availity Essentials
Recent Updates
CommercialMedicare AdvantageJune 6, 2025
National Drug Codes (NDCs) are required for outpatient claimsMedicare AdvantageJune 3, 2025
Precertification/prior authorization requirement changesEffective October 1, 2025
CommercialJune 2, 2025
Specialty Pharmacy Updates: Prior Authorization Changes Effective June 2025CommercialMedicare 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 AdvantageJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareCommercialMedicare AdvantageJune 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 proceduresCommercialJune 1, 2025
Clinical Criteria updates for specialty pharmacyCommercialMay 30, 2025
Key updates to the Designated Medical Specialty Pharmacy Drug ListCommercialMedicare AdvantageMay 27, 2025
Boost your roster submission skills with Availity EssentialsCommercialMay 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
CommercialMay 1, 2025
Essential updates to provider manual effective July 1, 2025CommercialMay 1, 2025
Professional provider fee schedule notificationMedicare AdvantageMay 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
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 SolutionsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalCommercialMedicare AdvantageApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsCommercialMarch 27, 2025
Specialty pharmacy updates — April 2025Medicare AdvantageMarch 27, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
CommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMedicare AdvantageMarch 1, 2025
Electronic payments starting in August 2025CommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMedicare AdvantageMarch 1, 2025
Electronic Explanation of Payment starting in AugustCommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Precertification list change notification March 1, 2025CommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestation