CommercialMedicare AdvantageMedicaidApril 1, 2025

April 2025 Provider Newsletter

Featured Articles

PharmacyMedicare AdvantageMarch 3, 2025

Important change to your patients’ specialty prescriptions


Administrative

AdministrativeMedicaidApril 1, 2025

After hours for primary care physicians

AdministrativeCommercialDecember 1, 2024

Physician Access/ Appointment Availability Standards

Digital SolutionsCommercialMedicare AdvantageMedicaidFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency

Education & Training

Education & TrainingMedicaidMarch 31, 2025

School‑Based Health Care Benefit Expansion effective May 1, 2025

Education & TrainingCommercialMedicare AdvantageMedicaidApril 1, 2025

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

Education & TrainingCommercialMedicare AdvantageMedicaidJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

Education & TrainingCommercialMedicare AdvantageMedicaidFebruary 28, 2025

Resources to support diverse patients and communities

Policy Updates

Policy UpdatesMedicaidMarch 28, 2025

InterQual March 2025 Updates

Policy UpdatesCommercialMarch 25, 2025

InterQual March 2025 updates

Policy UpdatesMedicaidFebruary 26, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesMedicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Prior AuthorizationCommercialApril 1, 2025

Precertification list change notification April 1, 2025

Prior AuthorizationMedicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Prior AuthorizationMedicare AdvantageMarch 26, 2025

Prior authorization requirement changes

Effective July 1, 2025

Prior AuthorizationMedicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Products & Programs

PharmacyCommercialMarch 27, 2025

Specialty pharmacy updates — April 2025

PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

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