Key Updates
Medicare AdvantageJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
Recent Updates
Medicare AdvantageJuly 18, 2025
Enhancing patient care with the House Call ProgramMedicare AdvantageJuly 8, 2025
Phishing scam alert — impersonating CMSMedicare AdvantageJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersMedicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expandedEffective November 1, 2025
Axtle, Bizengri, and Bynfezia pen
Medicare AdvantageJune 25, 2025
Implementation of chargemaster‑based claims edit for ER levelingMedicare AdvantageJune 25, 2025
A quick guide to understanding JW and JZ modifiersMedicare AdvantageJune 20, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansMedicare AdvantageJune 17, 2025
National Drug Codes (NDCs) are required for professional and outpatient claimsMedicare AdvantageJune 16, 2025
Specialty pharmacy precertification list expansion — key updatesMedicare AdvantageJune 13, 2025
Preventing flu: drive the change through vaccinationMedicare AdvantageJune 11, 2025
Streamlining behavioral health authorizations via Availity EssentialsMedicare AdvantageJune 3, 2025
Combat diabetes: Close the statin therapy gap for better heart healthMedicare AdvantageJune 3, 2025
Precertification/prior authorization requirement changes effective November 1, 2025Effective November 1, 2025
Medicare AdvantageJune 3, 2025
National Drug Codes (NDC) are required for outpatient claimsMedicare AdvantageMay 30, 2025
Join the 2025 Clinical Quality in Practice webinar seriesMedicare AdvantageMay 27, 2025
Bridging the gap: Enhancing medication adherence for better health outcomesMedicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
Medicare AdvantageMay 22, 2025
Claims guidance: updating inpatient and outpatient bill typesMedicare AdvantageMay 21, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareMedicare AdvantageMay 19, 2025
Bridging the gap: enhancing medication adherence for better health outcomesMedicare AdvantageMay 9, 2025
Heart health spotlight: leveraging statin therapy for diabetesMedicare AdvantageApril 30, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesMedicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 25, 2025
Medicare AdvantageApril 22, 2025
Additional drug codes added to medical claims edit systemMedicare AdvantageApril 16, 2025
New specialty pharmacy medical step therapy requirementEffective June 1, 2025
Hercessi
Medicare AdvantageApril 16, 2025
Specialty pharmacy preapproval list updateEffective August 1, 2025
Jubbonti; Wyost
Medicare AdvantageMarch 27, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsMedicare AdvantageMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
Medicare AdvantageMarch 3, 2025
Important change to your patients’ specialty prescriptionsMedicare AdvantageFebruary 28, 2025
Resources to support diverse patients and communitiesMedicare AdvantageJanuary 23, 2025
Steamfitters Local Union No. 420 retirees join our PPO planMedicare AdvantageJanuary 23, 2025
2025 Clinical Quality in Practice webinar seriesMedicare AdvantageDecember 31, 2024
Important information about specialty prescriptionsMedicare AdvantageDecember 30, 2024
Kroger Specialty Pharmacy acquisitionMedicare AdvantageDecember 30, 2024
Enhance patient coordination with Total Member ViewMedicare AdvantageDecember 23, 2024
Specialty pharmacy precertification list expansionMedicare AdvantageDecember 23, 2024
Specialty Pharmacy Precertification and Step Therapy list expansionEffective April 1, 2025
Medicare AdvantageDecember 19, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesMedicare AdvantageDecember 16, 2024
Shortage of repackaged bevacizumab for ophthalmic useMedicare AdvantageDecember 4, 2024
Medical Policies and Clinical Utilization Management Guidelines updateEffective January 5, 2024
Medicare AdvantageNovember 19, 2024
Medicare Part D overhaul: What's new in 2025 for your prescription drug costs?