Key Updates
MedicaidMarch 31, 2025
School‑Based Health Care Benefit Expansion effective May 1, 2025
CommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity Essentials
MedicaidMarch 26, 2025
You are invited: CCC plus waiver provider and nursing facility office hours
CommercialMedicare AdvantageMedicaidFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiency
Recent Updates
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines UpdateEffective May 25, 2025
MedicaidApril 22, 2025
You are invited: care provider coding educationMedicaidApril 21, 2025
Prevent cavities early: integrate fluoride varnish at well-child visitsMedicare 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
CommercialMedicare AdvantageApril 16, 2025
Provider Training Opportunity: You are invited: strategies for enhancing cardiovascular care and managementMedicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsMedicare AdvantageApril 2, 2025
HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025MedicaidApril 1, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 1, 2025
CommercialApril 1, 2025
Precertification list change notification April 1, 2025CommercialMedicare AdvantageMedicaidApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalMedicaidApril 1, 2025
After hours for primary care physiciansMedicare AdvantageMarch 31, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025MedicaidMarch 31, 2025
Quarterly pharmacy formulary change noticeMedicaidMarch 31, 2025
School‑Based Health Care Benefit Expansion effective May 1, 2025MedicaidMarch 28, 2025
InterQual March 2025 UpdatesCommercialMarch 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.CommercialMarch 25, 2025
InterQual March 2025 updatesMedicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMedicaidMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicaidMarch 19, 2025
Personalized Recovery Oriented Services program updatesMedicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
Medicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 3, 2025
Important change to your patients’ specialty prescriptionsCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 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 indicationsCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewMedicaidMarch 1, 2025
Reminder of operational enhancements to MLTC programCommercialMedicare AdvantageMedicaidMarch 1, 2025
Reminder: provider data attestationCommercialMedicare AdvantageMedicaidFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageMedicaidFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiencyMedicaidFebruary 25, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Orencia and Avsola
MedicaidFebruary 24, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Tevimbra and Tyenne
MedicaidFebruary 24, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Esperoct
Medicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education credits