Highlights

Key Updates

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

Education & TrainingCommercialMedicare AdvantageMedicaidMay 27, 2025

Boost your roster submission skills with Availity Essentials


What's New

Recent Updates

Policy Updates Medical Policy & Clinical GuidelinesMedicaidJune 12, 2025

Updated Clinical Practice Guidelines now available online

Policy Updates Prior AuthorizationMedicaidJune 9, 2025

Prior authorization requirement changes

Effective August 1, 2025

Education & TrainingMedicaidJune 5, 2025

Healthy Blood Pressure Recheck initiative: CBP

Products & Programs PharmacyCommercialMedicare AdvantageMedicaidJune 3, 2025

National Drug Codes (NDC) are required for outpatient claims

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyCommercialJune 2, 2025

Specialty pharmacy updates: June 2025

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

Products & Programs PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Education & Training WebinarsCommercialMedicare AdvantageMedicaidJune 1, 2025

Registration is now available for our upcoming CME webinar on Integrating Cancer Care

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidJune 1, 2025

Submitting BH authorizations in Availity Essentials

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Products & Programs PharmacyCommercialJune 1, 2025

Clinical Criteria updates for specialty pharmacy

Effective September 1, 2025

AdministrativeCommercialJune 1, 2025

Update to claims system for global surgical procedures

Quality ManagementMedicaidJune 1, 2025

Learn about members’ rights and responsibilities

Policy UpdatesMedicaidMay 28, 2025

Clinical Criteria updates

Effective June 30, 2025

Products & Programs PharmacyMedicaidMay 27, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Yesintek and Ziihera

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialMedicare AdvantageMedicaidMay 27, 2025

Boost your roster submission skills with Availity Essentials

AdministrativeCommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

Policy Updates Medical Policy & Clinical GuidelinesMedicaidMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective June 25, 2025

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools

Policy Updates Medical Policy & Clinical GuidelinesCommercialMay 1, 2025

Medical Policy and Clinical Guideline updates

Effective August 1, 2025

AdministrativeMedicare AdvantageMedicaidMay 1, 2025

Additional drug codes added to medical claims edit system

Products & Programs PharmacyCommercialMay 1, 2025

Clinical Criteria updates for specialty pharmacy

Effective August 1, 2025

AdministrativeMedicaidMay 1, 2025

CPT and HCPCS coding guidelines update

Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageMedicaidApril 30, 2025

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective August 1, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 24, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 25, 2025

Products & Programs DentalMedicaidApril 21, 2025

Prevent cavities early: integrate fluoride varnish at well-child visits

Products & Programs PharmacyMedicare AdvantageApril 18, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025
Hercessi

Products & Programs PharmacyMedicare AdvantageApril 18, 2025

Specialty pharmacy preapproval list update

Effective August 1, 2025
Jubbonti; Wyost

Policy Updates Prior AuthorizationMedicaidApril 11, 2025

Prior authorization requirement changes

Effective June 1, 2025
J9248

Policy UpdatesMedicaidApril 3, 2025

Clinical Criteria updates

Effective May 7, 2025

Policy Updates Medical Policy & Clinical GuidelinesMedicaidApril 1, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective May 1, 2025

Education & TrainingCommercialMedicare AdvantageMedicaidApril 1, 2025

Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized Metrics

Policy Updates Prior AuthorizationCommercialApril 1, 2025

Precertification list change notification April 1, 2025

AdministrativeMedicaidApril 1, 2025

After hours for primary care physicians

Policy Updates Reimbursement PoliciesCommercialApril 1, 2025

Clarification to reimbursement policy: Incident to Services and Billing Professional