CommercialMedicare AdvantageMedicaid Managed CareApril 1, 2025

April 2025 Provider Newsletter

Featured Articles

AdministrativeMedicaid Managed CareMarch 25, 2025

Submit complete and accurate provider data to ODM to prevent claim delays

PharmacyMedicare AdvantageFebruary 28, 2025

Important change to your patients’ specialty prescriptions

Effective April 1, 2025

Administrative

AdministrativeMedicare AdvantageMedicaid Managed CareApril 1, 2025

Skilled nursing facility frequently asked questions

AdministrativeMedicaid Managed CareMarch 10, 2025

Upcoming changes: EVV compliance guidelines and deadlines

Digital SolutionsCommercialMedicare AdvantageFebruary 28, 2025

Availity launches enhanced provider enrollment features for improved efficiency

Education & Training

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareFebruary 28, 2025

Resources to support diverse patients and communities

Education & TrainingMedicaid Managed CareApril 1, 2025

You are invited: Provider Advisory Council meeting

Education & TrainingCommercialMedicare AdvantageMedicaid Managed CareJanuary 1, 2025

Enhance billing and coding accuracy with new Payment Integrity training

WebinarsCommercialMedicare AdvantageMedicaid Managed CareApril 1, 2025

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

WebinarsMedicaid Managed CareMarch 1, 2025

You are invited: general orientation

WebinarsMedicaid Managed CareApril 1, 2025

You are invited: doula orientation

WebinarsMedicaid Managed CareMarch 1, 2025

You are invited: behavioral health orientation

WebinarsMedicaid Managed CareMarch 1, 2025

You are invited: optimizing outcomes — effective well visits

Policy Updates

Policy UpdatesMedicare AdvantageFebruary 27, 2025

Clinical Criteria updates

Effective March 28, 2025

Policy UpdatesMedicaid Managed CareMarch 27, 2025

Clinical Criteria updates
Effective May 1, 2025

Medical Policy & Clinical GuidelinesMedicare AdvantageMarch 11, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 12, 2025

Medical Policy & Clinical GuidelinesMedicaid Managed CareMarch 26, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective April 28, 2025

Prior AuthorizationMedicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Prior AuthorizationMedicaid Managed CareMarch 26, 2025

Prior authorization requirement changes

Effective May 1, 2025

Prior AuthorizationMedicare AdvantageMarch 6, 2025

Prior authorization requirement changes
Effective July 1, 2025

Reimbursement PoliciesCommercialApril 1, 2025

Clarification to reimbursement policy: Incident to Services and Billing — Professional

Products & Programs

PharmacyCommercialMarch 27, 2025

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Specialty pharmacy updates — April 2025

PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

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