June 1, 2025

June 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageMedicaid

Featured Articles

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

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Administrative

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

AdministrativeMedicaidMay 15, 2025

Reconciliation due to rate updates: acute DRG, exempt hospitals, and exempt hospital unit services

AdministrativeCommercialJune 1, 2025

Update to claims system for global surgical procedures for professional providers

Digital SolutionsCommercialMedicare AdvantageMedicaidMarch 1, 2025

Reminder: provider data attestation

Digital SolutionsCommercialMedicare AdvantageMedicaidJune 1, 2025

Submitting BH authorizations in Availity Essentials

Education & Training

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

WebinarsCommercialMedicare AdvantageMedicaidJune 1, 2025

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

Policy Updates

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

Medical Policy & Clinical GuidelinesMedicaidMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective June 25, 2025

Products & Programs

PharmacyMedicaidMay 27, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Yesintek and Ziihera

PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

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

PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

PharmacyCommercialJune 1, 2025

Clinical Criteria updates for specialty pharmacy

Effective September 1, 2025

Quality Management

Quality ManagementMedicaidJune 1, 2025

Navigating health with confidence through the Complex Case Management Program

Quality ManagementMedicaidJune 1, 2025

Learn about members’ rights and responsibilities

Quality ManagementMedicaidJune 1, 2025

Utilization management: prioritizing appropriate care and transparency

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