Key Updates
CommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar series
Medicaid Managed CareJanuary 15, 2025
Updated billing guidance for hospice billing for nursing facility room and board (HCPC T2046) and ventilator/ventilator‑weaning services
Recent Updates
CommercialFebruary 1, 2025
New reimbursement policy: Place of Service — ProfessionalCommercialFebruary 1, 2025
Corrected claim guidance for the Federal Employee Program®CommercialMedicare AdvantageFebruary 1, 2025
New Communication Center added to Availity EssentialsCommercialFebruary 1, 2025
Pharmacy information available on our provider websiteCommercialMedicare AdvantageFebruary 1, 2025
2025 Clinical Quality in Practice webinar seriesCommercialFebruary 1, 2025
Designated specialty pharmacy network updatesCommercialFebruary 1, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical records needed for accurate payment of certain facility inpatient claimsCommercialFebruary 1, 2025
Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)CommercialFebruary 1, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Reimbursement policy update: Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and FacilityMedicaid Managed CareFebruary 1, 2025
Join our Provider Advisory CouncilMedicare AdvantageJanuary 28, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 27, 2025
Key formulary updates: effective January 1, 2025CommercialJanuary 22, 2025
Breast Cancer Screening (BCS-E) 2025CommercialJanuary 22, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025CommercialJanuary 21, 2025
Eye Exam for Patients with Diabetes (EED) 2025CommercialJanuary 21, 2025
Controlling High Blood Pressure (CBP)CommercialJanuary 17, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 16, 2025
Asthma Medication Ratio (AMR) 2025CommercialJanuary 16, 2025
Submitting authorization for NICU services facilitates accurate and timely claims processingCommercialJanuary 16, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025Medicaid Managed CareJanuary 15, 2025
Updated billing guidance for hospice billing for nursing facility room and board (HCPC T2046) and ventilator/ventilator‑weaning servicesCommercialJanuary 14, 2025
Authorization for post‑acute care services for FEP membersMedicare AdvantageJanuary 13, 2025
Statin Therapy for Patients with Cardiovascular Disease (SPC) 2025Medicare AdvantageJanuary 13, 2025
Colorectal Cancer Screening (COL‑E) 2025Medicare AdvantageJanuary 13, 2025
Kidney Health Evaluation for Patients With Diabetes (KED) 2025CommercialJanuary 13, 2025
Medication Adherence 2025Medicare AdvantageJanuary 12, 2025
Medication Adherence 2025Medicare AdvantageJanuary 9, 2025
Advanced Illness and Frailty 2025Medicare AdvantageJanuary 9, 2025
Transition of Care (TRC) 2025Medicare AdvantageJanuary 8, 2025
Breast Cancer Screening (BCS-E) 2025Medicaid Managed CareJanuary 8, 2025
New specialty pharmacy medical step therapy requirementsMedicare AdvantageJanuary 7, 2025
Follow‑up After Emergency Department Visit for Patients With Multiple High‑Risk Chronic Conditions (FMC) 2025Medicaid Managed CareJanuary 7, 2025
Prior authorization updates for medications billed under the medical benefitEffective March 1, 2025
Kisunla and Piasky
Medicare AdvantageJanuary 6, 2025
Adult Immunization Status (AIS‑E) 2025CommercialJanuary 6, 2025
HEDIS Desktop Reference Guide for Commercial 2025CommercialMedicare AdvantageMedicaid Managed CareJanuary 1, 2025
Enhance billing and coding accuracy with new Payment Integrity trainingMedicaid Managed CareJanuary 1, 2025
You are invited: Review the Value-Added Benefits and Social Determinants of Health programCommercialJanuary 1, 2025
Introducing Coupe Health — quality care with clear pricing and no upfront paymentsCommercialJanuary 1, 2025
CAA: Providers required to verify online provider directory informationMedicaid Managed CareJanuary 1, 2025
Updates to correct coding editingMedicaid Managed CareJanuary 1, 2025
You are invited: Medicaid provider orientationMedicaid Managed CareJanuary 1, 2025
You are invited: Behavioral health provider orientationMedicaid Managed CareJanuary 1, 2025
You are invited: Nursing facility webinarMedicaid Managed CareJanuary 1, 2025
You are invited: Hospice webinarMedicare AdvantageJanuary 1, 2025
Announcing Health Perks — earn rewards for your healthcare activitiesCommercialJanuary 1, 2025
2025 FEHB and PSHB information available onlineCommercialJanuary 1, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — December 2024Medicaid Managed CareJanuary 1, 2025
Guidance for mental health and addiction services providersMedicare AdvantageJanuary 1, 2025
Kroger Specialty Pharmacy acquisition