July 1, 2025

July 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI Programs

Featured Articles

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

WebinarsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Join the 2025 Clinical Quality in Practice webinar series

Administrative

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

AdministrativeMedicare AdvantageJune 23, 2025

Essential information for providers: understanding Medicare Advantage group retiree plans

AdministrativeCommercialJuly 1, 2025

Update: essential ICD‑10‑CM compliance for outpatient facility claims

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

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

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025

Streamlining behavioral health authorizations via Availity Essentials

Digital SolutionsMedicare AdvantageJune 17, 2025

Specialty pharmacy precertification list expansion — key updates

Education & Training

Education & TrainingMedicare AdvantageJuly 1, 2025

Combat diabetes: Close the statin therapy gap for better heart health

Education & TrainingCommercialBadgerCare Plus and Medicaid SSI ProgramsJune 17, 2025

National Drug Code required for professional and facility outpatient claims

Policy Updates

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsMay 28, 2025

Clinical Criteria updates

Effective June 30, 2025

Policy UpdatesMedicare AdvantageJune 2, 2025

Clinical Criteria updates

Effective July 6, 2025

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 13, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025

Prior AuthorizationMedicare AdvantageJune 3, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025

Reimbursement PoliciesCommercialJuly 1, 2025

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

Reimbursement PoliciesCommercialJuly 1, 2025

Reimbursement policy update: Bundled Services and Supplies — Professional

Products & Programs

PharmacyCommercialMay 30, 2025

Key updates to the Designated Medical Specialty Pharmacy Drug List

PharmacyCommercialJune 2, 2025

Specialty pharmacy updates: June 2025

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