Highlights

Key Updates

Policy Updates Prior AuthorizationCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Policy UpdatesCommercialJune 13, 2025

Streamlined claim submission process update


What's New

Recent Updates

Policy Updates Prior AuthorizationCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Policy Updates Reimbursement PoliciesCommercialJuly 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 Facility

AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

AdministrativeCommercialJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

AdministrativeMedicare AdvantageJuly 1, 2025

A quick guide to understanding JW and JZ modifiers

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025

Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experience

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

Reimbursement policy update: Nurse Practitioner and Physician Assistant services

AdministrativeCommercialJuly 1, 2025

Enroll with Availity to verify your provider data

Policy Updates Reimbursement PoliciesMedicaid Managed CareJuly 1, 2025

Reimbursement Policy Update: Multiple Radiology Payment Reduction

Education & TrainingMedicaid Managed CareJuly 1, 2025

You are invited: Provider Engagement Council meeting

AdministrativeCommercialJuly 1, 2025

View your Fee Schedule in Availity Essentials Payer Spaces

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025

Streamlining behavioral health authorizations via Availity Essentials

Education & TrainingMedicare AdvantageJuly 1, 2025

Combat diabetes: Close the statin therapy gap for better heart health

Education & Training WebinarsCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025

National Drug Codes (NDCs) are required for professional and outpatient claims

Products & Programs PharmacyMedicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

Effective November 1, 2025
Axtle, Bizengri, and Bynfezia pen

Policy Updates Medical Policy & Clinical GuidelinesCommercialJune 25, 2025

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

Medical Policies and Clinical Guidelines updates — August 2025

Administrative Digital SolutionsMedicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Policy UpdatesCommercialJune 13, 2025

Streamlined claim submission process update

Education & TrainingMedicaid Managed CareJune 11, 2025

Doula claim submission FAQ

Policy Updates Prior AuthorizationMedicaid Managed CareJune 9, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Products & Programs PharmacyCommercialMedicare AdvantageJune 6, 2025

National Drug Codes (NDCs) are required for outpatient claims

Policy Updates Prior AuthorizationMedicare AdvantageJune 3, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025

Education & TrainingMedicaid Managed CareJune 3, 2025

Attention Ohio Medicaid Doulas

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyCommercialJune 2, 2025

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

Specialty pharmacy updates: June 2025

Quality ManagementMedicaid Managed CareJune 1, 2025

How care providers can support members in challenging times

Quality ManagementMedicaid Managed CareJune 1, 2025

Your patients' healthcare journey: understanding their rights and responsibilities

Quality ManagementMedicaid Managed CareJune 1, 2025

Insights on utilization management

AdministrativeCommercialJune 1, 2025

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

Update to Chargemaster Audit Process

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Administrative Digital SolutionsCommercialMedicare AdvantageMedicaid Managed CareJune 1, 2025

Submitting BH authorizations in Availity Essentials

Education & Training WebinarsCommercialMedicare AdvantageMedicaid Managed CareJune 1, 2025

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

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Products & Programs PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

Products & Programs PharmacyCommercialMay 30, 2025

Key updates to the Designated Medical Specialty Pharmacy Drug List

Effective August 1, 2025
Blincyto

Education & TrainingMedicaid Managed CareMay 27, 2025

You are invited: care provider coding education

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialMedicare AdvantageMay 27, 2025

Boost your roster submission skills with Availity Essentials

AdministrativeCommercialMay 22, 2025

Action required: annual patient safety attestation

Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

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

Policy Updates Medical Policy & Clinical GuidelinesMedicaid Managed CareMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective June 25, 2025

Products & Programs PharmacyMedicaid Managed CareMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Tevimbra and Tyenne

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025