Highlights

Key Updates

Policy Updates Prior AuthorizationCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Education & TrainingBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Earn CME credits: Attend our engaging webinars


What's New

Recent Updates

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Clinical Criteria updates

Effective August 3, 2025

Policy Updates Prior AuthorizationCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Benefits of utilization management attestations: a guide for care providers

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

New reimbursement policy: Code and Clinical Editing Guidelines — Professional and Facility

Policy Updates Reimbursement PoliciesCommercialJuly 1, 2025

Reimbursement policy update: Bundled Services and Supplies — Professional

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 AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

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

AdministrativeCommercialJuly 1, 2025

Enroll with Availity to verify your provider data

Education & TrainingBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Earn CME credits: Attend our engaging webinars

Administrative Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 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 AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

Products & Programs PharmacyCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

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

Education & TrainingMedicare AdvantageJune 27, 2025

Specialty pharmacy precertification list expanded

Policy Updates Medical Policy & Clinical GuidelinesCommercialJune 25, 2025

Medical Policies and Clinical Guidelines updates — August 2025

Education & TrainingCommercialBadgerCare Plus and Medicaid SSI ProgramsJune 17, 2025

National Drug Code required for professional and facility outpatient claims

Administrative Digital SolutionsMedicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Policy Updates Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 13, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Policy Updates Prior AuthorizationMedicare AdvantageJune 3, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025

Products & Programs PharmacyCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 3, 2025

National Drug Codes (NDC) are required for outpatient claims

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Products & Programs PharmacyCommercialJune 2, 2025

Specialty pharmacy updates: June 2025

Products & Programs PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Navigating health with confidence through the Complex Case Management program

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Learn about members’ rights and responsibilities

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Utilization management: prioritizing appropriate care and transparency

Education & TrainingCommercialJune 1, 2025

You are invited: claims appeals on Availity Essentials

AdministrativeCommercialJune 1, 2025

Updated 2025 provider manual now available

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Administrative Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Submitting BH authorizations in Availity Essentials

Education & Training WebinarsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

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

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Education & TrainingCommercialJune 1, 2025

Prior authorization for NICU services: Clinical UM Guideline available

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

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsMay 28, 2025

Clinical Criteria updates

Effective June 30, 2025

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 27, 2025

Boost your roster submission skills with Availity Essentials

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 GuidelinesBadgerCare Plus and Medicaid SSI ProgramsMay 21, 2025

Medical Policies and Clinical Utilization Management Guidelines update

Effective June 25, 2025

Products & Programs PharmacyBadgerCare Plus and Medicaid SSI ProgramsMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective July 1, 2025
Tevimbra and Tyenne

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsMay 14, 2025

Carelon Medical Benefits Management, Inc. updates

Effective June 20, 2025

Policy UpdatesMedicare AdvantageMay 13, 2025

Clinical Criteria updates

Effective June 20, 2025

Education & TrainingCommercialMay 1, 2025

Streamline your prior authorizations with our digital tools