Key Updates
BadgerCare Plus and Medicaid SSI ProgramsApril 11, 2025
Prior authorization requirement changes
Effective June 1, 2025
CommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity Essentials
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiency
Recent Updates
BadgerCare Plus and Medicaid SSI ProgramsApril 25, 2025
Carelon Medical Benefits Management, Inc. updatesEffective June 15, 2025
Medicare AdvantageApril 24, 2025
Medical Policies and Clinical Utilization Management Guidelines UpdateEffective May 25, 2025
CommercialApril 22, 2025
Required patient safety standards attestationMedicare 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
CommercialMedicare AdvantageApril 16, 2025
Provider Training Opportunity: You are invited: strategies for enhancing cardiovascular care and managementBadgerCare Plus and Medicaid SSI ProgramsApril 14, 2025
Updated Clinical Practice Guidelines now available onlineMedicare AdvantageApril 11, 2025
Submit preapproval requests for post‑acute care services for Medicare group retiree members to Carelon Post Acute SolutionsBadgerCare Plus and Medicaid SSI ProgramsApril 11, 2025
Prior authorization requirement changesEffective June 1, 2025
CommercialApril 10, 2025
Medical Policies and Clinical Guidelines updates, May 2025BadgerCare Plus and Medicaid SSI ProgramsApril 3, 2025
Clinical Criteria updatesEffective May 7, 2025
Medicare AdvantageApril 2, 2025
HEDIS measure: Statin Use in Persons with Diabetes (SUPD) 2025BadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 1, 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsCommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalBadgerCare Plus and Medicaid SSI ProgramsMarch 28, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesCommercialMarch 28, 2025
Streamline your workflow: Submit BH authorizations through Availity EssentialsCommercialMarch 27, 2025
Specialty pharmacy updates — April 2025Medicare AdvantageMarch 27, 2025
Outpatient preapproval update from Carelon Medical Benefits Management, Inc.BadgerCare Plus and Medicaid SSI ProgramsMarch 24, 2025
Carelon Medical Benefits Management, Inc. updatesEffective on May 1, 2025
Medicare AdvantageMarch 19, 2025
Medicare Part B preapproval expands with new drug additionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMarch 19, 2025
Technical difficulties: My Diverse PatientsMedicare AdvantageMarch 14, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025Medicare AdvantageMarch 14, 2025
Controlling High Blood Pressure (CBP) 2025Medicare AdvantageMarch 11, 2025
Care for Older Adults (COA) 2025Medicare AdvantageMarch 11, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective April 12, 2025
CommercialMarch 1, 2025
Update: Drug claims edits to focus on FDA‑approved indicationsCommercialMarch 1, 2025
Changes in Postal Service Health Benefits for 2025CommercialMarch 1, 2025
New coding guidelines: include the anatomic modifierCommercialMarch 1, 2025
Certain modifiers for outpatient claims will receive prepayment coding reviewCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMarch 1, 2025
Reminder: provider data attestationCommercialMarch 1, 2025
You are invited: Availity Essentials overviewMedicare AdvantageFebruary 28, 2025
Important change to your patients’ specialty prescriptionsEffective April 1, 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsFebruary 28, 2025
Resources to support diverse patients and communitiesCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsFebruary 28, 2025
Update: Availity launches enhanced provider enrollment features for improved efficiencyBadgerCare Plus and Medicaid SSI ProgramsFebruary 26, 2025
Clinical Criteria updatesEffective March 28, 2025
BadgerCare Plus and Medicaid SSI ProgramsFebruary 25, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Orencia and Avsola
BadgerCare Plus and Medicaid SSI ProgramsFebruary 24, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Tevimbra and Tyenne
Medicare AdvantageFebruary 21, 2025
Advanced Illness and Frailty Exclusions 2025CommercialFebruary 21, 2025
Start 2025 with an easy way to earn continuing education creditsBadgerCare Plus and Medicaid SSI ProgramsFebruary 19, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Anktiva, Hercessi, and Imdelltra
BadgerCare Plus and Medicaid SSI ProgramsFebruary 17, 2025
MCG Care Guidelines 29th editionEffective June 1, 2025
CommercialFebruary 11, 2025
Developmental screening in the first three years of lifeCommercialFebruary 11, 2025
Glycemic Status Assessment for Patients with Diabetes (GSD) 2025CommercialFebruary 11, 2025
Chlamydia Screening (CHL) 2025