Key Updates
CommercialMedicare AdvantageMay 27, 2025
Boost your roster submission skills with Availity Essentials
CommercialMedicare AdvantageMarch 1, 2025
Reminder: provider data attestation
Recent Updates
CommercialMay 30, 2025
Key updates to the Designated Medical Specialty Pharmacy Drug ListMedicaid Managed CareMay 27, 2025
You are invited: care provider coding educationMedicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMedicare AdvantageMay 27, 2025
Boost your roster submission skills with Availity EssentialsCommercialMay 22, 2025
Action required: annual patient safety attestationMedicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
Medicaid Managed CareMay 21, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective June 25, 2025
Medicaid Managed CareMay 20, 2025
Prior authorization updates for medications billed under the medical benefitEffective July 1, 2025
Tevimbra and Tyenne
CommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsCommercialMay 1, 2025
Unlock the power of electronic claims with Availity EssentialsMedicare AdvantageMedicaid Managed CareMay 1, 2025
Additional drug codes added to medical claims edit systemMedicaid Managed CareMay 1, 2025
You are invited: doula orientationCommercialMedicare AdvantageApril 30, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective August 1, 2025
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 25, 2025
Medicaid Managed CareApril 22, 2025
Carelon Medical Benefits Management, Inc. updatesEffective May 23, 2025
Medicare AdvantageApril 18, 2025
New specialty pharmacy medical step therapy requirementEffective June 1, 2025
Hercessi
Medicare AdvantageApril 18, 2025
Specialty pharmacy preapproval list updateEffective August 1, 2025
Jubbonti; Wyost
Medicaid Managed CareApril 15, 2025
Prior authorization updates for medications billed under the medical benefitEffective June 1, 2025
Anktiva, Hercessi and Imdelltra
Medicare 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 educationMedicaid Managed CareApril 1, 2025
Precertification/prior authorization requirement changesEffective June 1, 2025
Medicaid Managed CareApril 1, 2025
You are invited: Provider Advisory Council meetingMedicaid Managed CareApril 1, 2025
You are invited: doula orientationMedicare AdvantageMedicaid Managed CareApril 1, 2025
Update: Skilled nursing facility frequently asked questionsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalCommercialMedicare AdvantageMedicaid Managed CareApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialMarch 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 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
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsMedicaid Managed CareMarch 1, 2025
Achieve accurate reimbursements for behavioral health claimsCommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierMedicaid Managed CareMarch 1, 2025
You are invited: behavioral health orientationMedicaid Managed CareMarch 1, 2025
You are invited: general orientation