Highlights

Key Updates

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

Administrative Digital SolutionsCommercialNovember 20, 2024

Notification of authorization fax number changes

AdministrativeMedicare AdvantageNovember 18, 2024

New York 2025 Medicare Advantage plan changes

AdministrativeMedicare AdvantageNovember 18, 2024

New York 2025 Medicare Advantage plan changes

Products & Programs PharmacyCommercialNovember 18, 2024

Material adverse change

Specialty pharmacy updates — December 2024

Administrative Digital SolutionsMedicare AdvantageNovember 18, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

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

Clinical Criteria updates

Effective December 18, 2024

Products & Programs PharmacyMedicare AdvantageNovember 14, 2024

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

Behavioral HealthMedicaidNovember 13, 2024

Assertive Community Treatment (ACT) Provider Bulletin

Policy UpdatesMedicaidNovember 7, 2024

Clinical Criteria updates

Effective December 11, 2024

Products & Programs PharmacyMedicaidNovember 5, 2024

Prior authorization updates for medications billed under the medical benefit

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidNovember 1, 2024

Roster Automation updates: roster download functionality

Behavioral HealthCommercialNovember 1, 2024

Introducing a new Applied Behavior Analysis Provider Resource Guide

Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Material adverse change

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Administrative Digital SolutionsMedicaidNovember 1, 2024

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

Products & Programs PharmacyCommercialNovember 1, 2024

Material adverse change

Clinical Criteria updates for specialty pharmacy

Administrative Digital SolutionsCommercialNovember 1, 2024

Now live: view your fee schedule in Availity Essentials Payer Spaces

AdministrativeCommercialNovember 1, 2024

Material adverse change

Anesthesia billed time units — Commercial

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

Education & TrainingMedicaidNovember 1, 2024

After hours for primary care physicians

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Material adverse change

Precertification List Change Notification — November 1, 2024

Codes J3393 and J3394

Policy UpdatesMedicare AdvantageOctober 30, 2024

Clinical Criteria updates

Effective December 2, 2024

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

Education & TrainingMedicaidOctober 23, 2024

CPT Category II update

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 Prior AuthorizationMedicaidOctober 10, 2024

Prior authorization requirement changes

Effective December 1, 2024

Quality ManagementCommercialMedicare AdvantageOctober 7, 2024

HEDIS Measure Tips — Cardiac Rehabilitation (CRE) 2025

Quality Management Optimizing HEDIS & STARSMedicare AdvantageOctober 4, 2024

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

AdministrativeMedicaidOctober 3, 2024

PrEP Awareness Week

Quality Management Optimizing HEDIS & STARSCommercialMedicare AdvantageOctober 3, 2024

Blood Pressure Control for Patients With Diabetes (BPD) 2025

Quality ManagementMedicare AdvantageOctober 2, 2024

Pharmacotherapy Management of COPD Exacerbation (PCE) 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidOctober 2, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective November 3, 2024

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Products & Programs PharmacyCommercialOctober 1, 2024

Pharmacy information available on our provider website