Key Updates
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMarch 1, 2025
Reminder: provider data attestation
Recent Updates
Medicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirementsEffective July 1, 2025
Pavblu, Ahzantive, Enzeevu, Opuviz, and Yesafili
BadgerCare Plus and Medicaid SSI ProgramsMay 21, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective June 25, 2025
BadgerCare Plus and Medicaid SSI ProgramsMay 20, 2025
Prior authorization updates for medications billed under the medical benefitEffective July 1, 2025
Tevimbra and Tyenne
BadgerCare Plus and Medicaid SSI ProgramsMay 14, 2025
Carelon Medical Benefits Management, Inc. updatesEffective June 20, 2025
CommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 1, 2025
Additional drug codes added to medical claims edit systemBadgerCare Plus and Medicaid SSI ProgramsMay 1, 2025
Enhancing your learning experience: latest updates in Provider PathwaysCommercialMedicare AdvantageApril 30, 2025
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective August 1, 2025
BadgerCare Plus and Medicaid SSI ProgramsApril 29, 2025
New preapproval requirements for GivlaariEffective June 1, 2025
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
BadgerCare 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
Codes: J9248 and L5841
CommercialApril 10, 2025
Medical Policies and Clinical Guidelines updates, May 2025BadgerCare Plus and Medicaid SSI ProgramsApril 3, 2025
Clinical Criteria updatesEffective May 7, 2025
BadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective May 1, 2025
CommercialApril 1, 2025
Clarification to reimbursement policy: Incident to Services and Billing — ProfessionalCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsApril 1, 2025
Register for our next webinar: Enhancing Diabetes Management — Focus on Standardized MetricsBadgerCare 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 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 reviewCommercialMarch 1, 2025
You are invited: Availity Essentials overviewCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMarch 1, 2025
Reminder: provider data attestationMedicare 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
BadgerCare Plus and Medicaid SSI ProgramsFebruary 19, 2025
Prior authorization updates for medications billed under the medical benefitEffective April 1, 2025
Anktiva, Hercessi, and Imdelltra