Key Updates
CommercialMedicare AdvantageMedicaid Managed CareAugust 1, 2025
You are invited: immunization measures webinar
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025
CommercialMedicare AdvantageJuly 23, 2025
Enhance care provider data accuracy with updated roster tools
Recent Updates
Medicaid Managed CareAugust 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective September 15, 2025
Medicare AdvantageAugust 1, 2025
Expanded specialty pharmacy precertification listCommercialAugust 1, 2025
SUD confidentiality protections for membersCommercialMedicare AdvantageMedicaid Managed CareAugust 1, 2025
You are invited: immunization measures webinarCommercialAugust 1, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Facility diagnostic radiopharmaceuticals and contrast mediaCommercialMedicare AdvantageAugust 1, 2025
Compatibility in care: sharing REL data to improve member healthCommercialAugust 1, 2025
Upcoming updates: medical claims edit system for self‑administered drugsCommercialAugust 1, 2025
New EMR messaging alerts aim to close gaps in care for ACA patientsMedicaid Managed CareAugust 1, 2025
Updated reimbursement procedure effective September 1, 2025CommercialAugust 1, 2025
Introducing a new Applied Behavior Analysis Provider Resource GuideMedicaid Managed CareJuly 25, 2025
Updated guidance: immunizations covered by VFCMedicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025Medicaid Managed CareJuly 24, 2025
Precertification/prior authorization requirement changesCommercialMedicare AdvantageJuly 23, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 22, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideCommercialMedicare AdvantageJuly 18, 2025
New mandatory fields in roster templateCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersMedicaid Managed CareJuly 1, 2025
You are invited: Provider Engagement Council meetingCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialJuly 1, 2025
Update: essential ICD‑10‑CM compliance for outpatient facility claimsCommercialJuly 1, 2025
View your Fee Schedule in Availity Essentials Payer SpacesMedicaid Managed CareJuly 1, 2025
Reimbursement Policy Update: Multiple Radiology Payment ReductionCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experienceMedicare AdvantageJuly 1, 2025
A quick guide to understanding JW and JZ modifiersCommercialJuly 1, 2025
Reimbursement policy update: Nurse Practitioner and Physician Assistant servicesCommercialJuly 1, 2025
A quick guide to understanding JW and JZ modifiersCommercialJuly 1, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
New reimbursement policy: Code and Clinical Editing Guidelines — Professional and FacilityMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Update: National Drug Codes (NDCs) are required for professional and outpatient claimsMedicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expandedEffective November 1, 2025
Axtle, Bizengri, and Bynfezia pen
CommercialJune 25, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — August 2025Medicare AdvantageJune 23, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansMedicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updatesCommercialJune 13, 2025
Streamlined claim submission process updateMedicaid Managed CareJune 11, 2025
Doula claim submission FAQMedicaid Managed CareJune 9, 2025
Precertification/prior authorization requirement changesEffective August 1, 2025
CommercialMedicare AdvantageJune 6, 2025
National Drug Codes (NDCs) are required for outpatient claimsMedicare AdvantageJune 3, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
Medicaid Managed CareJune 3, 2025
Attention Ohio Medicaid DoulasCommercialJune 2, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Specialty pharmacy updates: June 2025Medicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomes