June 1, 2025

June 2025 Provider Newsletter

Filter By: AllCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI Programs

Featured Articles

Education & TrainingMedicare AdvantageMay 27, 2025

Learn about annual Model of Care training for special needs plans

Education & TrainingCommercialJune 1, 2025

Availity Essentials Provider Overpayments application launch

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

Boost your roster submission skills with Availity Essentials

Administrative

AdministrativeCommercialMedicare AdvantageJune 1, 2025

LabCorp and Quest Diagnostics are in-network — reminder

AdministrativeCommercialJune 1, 2025

Updated 2025 provider manual now available

AdministrativeCommercialJune 1, 2025

Update to claims system for global surgical procedures for professional providers

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Submitting BH authorizations in Availity Essentials

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMarch 1, 2025

Reminder: provider data attestation

Education & Training

Education & TrainingCommercialJune 1, 2025

Prior authorization for NICU services: Clinical UM Guideline available

Education & TrainingMedicare AdvantageJune 1, 2025

Claims guidance: updating inpatient and outpatient bill types

Education & TrainingMedicare AdvantageJune 1, 2025

Bridging the gap: enhancing medication adherence for better health outcomes

Education & TrainingCommercialJune 1, 2025

You are invited: claims appeals on Availity Essentials

WebinarsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

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

Policy Updates

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsApril 25, 2025

Carelon Medical Benefits Management, Inc. updates

Effective July 26, 2025

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

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

PharmacyCommercialJune 1, 2025

Unlock updated pharmacy insights today — visit our provider website

PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Effective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili

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

Quality Management

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Utilization management: prioritizing appropriate care and transparency

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Learn about members’ rights and responsibilities

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025

Navigating health with confidence through the Complex Case Management program

WIBCBS-CDCRCM-083890-25-CPN83757