Key Updates
CommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity Essentials
Medicaid Managed CareMarch 26, 2025
Medical Policies and Clinical Utilization Management Guidelines update
Effective April 28, 2025
Medicaid Managed CareMarch 25, 2025
Submit complete and accurate provider data to ODM to prevent claim delays
Recent Updates
CommercialMedicare AdvantageApril 16, 2025
Provider Training Opportunity: You are invited: strategies for enhancing cardiovascular care and managementMedicaid Managed CareApril 15, 2025
Prior authorization updates for medications billed under the medical benefitMedicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsCommercialApril 10, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates, May 2025Medicaid Managed CareApril 7, 2025
You are invited: provider coding educationMedicare AdvantageApril 2, 2025
HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025Medicaid Managed CareApril 1, 2025
Precertification/prior authorization requirement changesEffective June 1, 2025
Medicaid Managed CareApril 1, 2025
You are invited: Provider Advisory Council meetingCommercialMedicare AdvantageMedicaid Managed CareApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalMedicaid Managed CareApril 1, 2025
You are invited: doula orientationMedicare AdvantageMedicaid Managed CareApril 1, 2025
Skilled nursing facility frequently asked questionsCommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsCommercialMarch 27, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Specialty pharmacy updates — April 2025Medicare AdvantageMarch 27, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.Medicaid Managed CareMarch 26, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 28, 2025
Medicaid Managed CareMarch 25, 2025
Submit complete and accurate provider data to ODM to prevent claim delaysMedicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageMedicaid Managed CareMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Medicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
Medicaid Managed CareMarch 10, 2025
Upcoming changes: EVV compliance guidelines and deadlinesCommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierMedicaid Managed CareMarch 1, 2025
You are invited: general orientationMedicaid Managed CareMarch 1, 2025
You are invited: behavioral health orientationMedicaid Managed CareMarch 1, 2025
You are invited: doula orientationCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025Medicaid Managed CareMarch 1, 2025
Achieve accurate reimbursements for behavioral health claimsCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestationMedicaid Managed CareMarch 1, 2025
Behind the scenes, get to know: Sheila BlackmoreMedicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptionsEffective April 1, 2025
Medicaid Managed CareFebruary 28, 2025
New preapproval review goes live April 1, 2025; register for trainingCommercialMedicare AdvantageMedicaid Managed CareFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageFebruary 28, 2025
Availity launches enhanced provider enrollment features for improved efficiencyMedicare AdvantageMedicaid Managed CareFebruary 25, 2025
Anthem will delegate care management to Carelon Health, Inc.Medicaid Managed CareFebruary 24, 2025
Preapproval updates for medications billed under the medical benefitEffective April 1, 2025
Amtagvi and Nexobrid
Medicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education creditsCommercialFebruary 18, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
MCG Care Guidelines 29th editionEffective June 1, 2025