Highlights

Key Updates

Administrative Digital SolutionsCommercialMedicaidDecember 26, 2024

Availity Essentials maternity update for providers

Quality ManagementCommercialMedicare AdvantageMedicaidOctober 25, 2024

Time to prepare for HEDIS medical record review


What's New

Recent Updates

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaidDecember 30, 2024

Enhance patient coordination with Total Member View

Products & Programs PharmacyCommercialDecember 27, 2024

Weight management program overview

Administrative Digital SolutionsCommercialMedicaidDecember 26, 2024

Availity Essentials maternity update for providers

Quality ManagementCommercialDecember 26, 2024

HEDIS Well Child and Immunizations Coding Bulletin 2025

Quality Management Optimizing HEDIS & STARSCommercialDecember 23, 2024

HEDIS CAT II Coding Bulletin 2025

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 23, 2024

Specialty pharmacy precertification list expansion

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 23, 2024

Specialty Pharmacy Precertification and Step Therapy list expansion

Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicaidDecember 19, 2024

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

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 19, 2024

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

Products & Programs PharmacyMedicare AdvantageAMH - Medicare AdvantageDecember 16, 2024

Shortage of repackaged bevacizumab for ophthalmic use

Policy UpdatesMedicare AdvantageDecember 6, 2024

Clinical Criteria updates

Effective January 9, 2025

AdministrativeCommercialMedicaidDecember 5, 2024

Update to anesthesia billed time units policy

Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 4, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective January 5, 2024

AdministrativeCommercialDecember 3, 2024

Outpatient system updates for 2025

AdministrativeCommercialDecember 3, 2024

Professional system updates for 2025

AdministrativeCommercialDecember 1, 2024

Members’ Rights and Responsibilities

Administrative Digital SolutionsMedicaidDecember 1, 2024

You are invited: Learn how Availity creates better efficiencies for care providers

Education & TrainingCommercialDecember 1, 2024

Physician Access/ Appointment Availability Standards

Behavioral HealthCommercialMedicare AdvantageDecember 1, 2024

Comprehensive, holistic care for obstructive sleep apnea

AdministrativeCommercialDecember 1, 2024

Important information about utilization management

AdministrativeCommercialDecember 1, 2024

Clinical practice and preventive health guidelines available online

Products & Programs Federal Employee Program (FEP)CommercialDecember 1, 2024

FEP excited to join PSHB program in 2025

Policy Updates Reimbursement PoliciesCommercialDecember 1, 2024

New reimbursement policy: Trauma Activation — Facility

Products & Programs PharmacyCommercialDecember 1, 2024

Kroger Specialty Pharmacy acquisition

AdministrativeCommercialDecember 1, 2024

Coordination of care

Products & Programs PharmacyCommercialDecember 1, 2024

Pharmacy information available online

AdministrativeCommercialDecember 1, 2024

PCP after‑hours access requirements

Products & Programs PharmacyCommercialDecember 1, 2024

Paragon Healthcare joins our medical specialty pharmacy provider network in 2025

AdministrativeCommercialDecember 1, 2024

Case Management program

Quality Management Optimizing HEDIS & STARSMedicare AdvantageNovember 26, 2024

HEDIS Category II Coding Bulletin 2025

Products & ProgramsCommercialNovember 21, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Administrative Digital SolutionsCommercialNovember 20, 2024

Notification of authorization fax number changes

Fax numbers that will be turned off as of December 15, 2024

AdministrativeMedicare AdvantageNovember 18, 2024

New York 2025 Medicare Advantage plan changes

Products & Programs PharmacyCommercialNovember 18, 2024

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

Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Precertification List Change Notification — November 1, 2024

Administrative Digital SolutionsCommercialNovember 1, 2024

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