Key Updates
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025
CommercialMedicare AdvantageJuly 23, 2025
Enhance care provider data accuracy with updated roster tools
CommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
Recent Updates
Medicaid 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 providersCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsCommercialMedicare 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 healthCommercialJuly 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
You are invited: Provider Engagement Council meetingMedicaid 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
A quick guide to understanding JW and JZ modifiersMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingCommercialJuly 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 FacilityCommercialJuly 1, 2025
Reimbursement policy update: Nurse Practitioner and Physician Assistant servicesCommercialMedicare AdvantageMedicaid Managed CareJuly 1, 2025
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 2025CommercialJune 1, 2025
Update to claims system for global surgical procedures for professional providersMedicaid Managed CareJune 1, 2025
How care providers can support members in challenging timesMedicaid Managed CareJune 1, 2025
Your patients' healthcare journey: understanding their rights and responsibilitiesMedicaid Managed CareJune 1, 2025
Insights on utilization managementCommercialJune 1, 2025
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Update to Chargemaster Audit ProcessMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialMedicare AdvantageMedicaid Managed CareJune 1, 2025
Submitting BH authorizations in Availity EssentialsCommercialJune 1, 2025
Upcoming changes to the provider manual effective September 2025CommercialMedicare AdvantageMedicaid Managed CareJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launch