Key Updates
CommercialMedicare AdvantageMedicaidMarch 19, 2025
Technical difficulties: My Diverse Patients
Medicare AdvantageMarch 3, 2025
Important change to your patients’ specialty prescriptions
CommercialMedicare AdvantageMedicaidFebruary 28, 2025
Availity launches enhanced provider enrollment features for improved efficiency
Recent Updates
Medicare 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 prescriptionsCommercialMedicare AdvantageMedicaidMarch 1, 2025
Reminder: provider data attestationMedicaidMarch 1, 2025
Reminder of operational enhancements to MLTC programCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
Precertification list change notification March 1, 2025CommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMedicare AdvantageMedicaidFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageMedicaidFebruary 28, 2025
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 creditsMedicaidFebruary 19, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Anktiva, Hercessi, and Imdelltra
CommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025CommercialFebruary 10, 2025
Colorectal Cancer Screening (COL-E) 2025MedicaidFebruary 4, 2025
You are invited: provider coding educationCommercialFebruary 4, 2025
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Medical records needed for accurate payment of certain facility inpatient claimsCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialMedicare AdvantageMedicaidFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Clinical Criteria updates for specialty pharmacyCommercialFebruary 1, 2025
Medical Policy and Clinical Guideline updatesCommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)MedicaidJanuary 31, 2025
Reconciliation due to All Patient Refined Diagnosis Related Groups (APR-DRGs) UpdateCommercialJanuary 30, 2025
PT and OT fee increase for Commercial products