Key Updates
CommercialJune 1, 2025
Availity Essentials Provider Overpayments application launch
Medicare AdvantageJune 1, 2025
Medicare preferred continuous glucose monitors
CommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminder
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 27, 2025
Boost your roster submission skills with Availity Essentials
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMarch 1, 2025
Reminder: provider data attestation
Recent Updates
CommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderMedicare AdvantageJune 1, 2025
Medicare preferred continuous glucose monitorsCommercialJune 1, 2025
Prior authorization for NICU services: Clinical UM Guideline availableCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launchMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Submitting BH authorizations in Availity EssentialsMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialJune 1, 2025
Updated 2025 provider manual now availableCommercialJune 1, 2025
You are invited: claims appeals on Availity EssentialsCommercialJune 1, 2025
Update to claims system for global surgical proceduresBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Utilization management: prioritizing appropriate care and transparencyBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Learn about members’ rights and responsibilitiesBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Navigating health with confidence through the Complex Case Management programCommercialMay 30, 2025
Key updates to the Designated Medical Specialty Pharmacy Drug ListBadgerCare Plus and Medicaid SSI ProgramsMay 28, 2025
Clinical Criteria updatesEffective June 30, 2025
Medicare AdvantageMay 27, 2025
Learn about annual Model of Care training for special needs plansCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 27, 2025
Boost your roster submission skills with Availity EssentialsMedicare 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
BadgerCare Plus and Medicaid SSI ProgramsMay 1, 2025
Enhancing your learning experience: latest updates in Provider PathwaysMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsMay 1, 2025
Additional drug codes added to medical claims edit systemCommercialMay 1, 2025
Free CE training: Lifestyle Medicine & Food as Medicine Essentials CourseCommercialMay 1, 2025
Streamline your prior authorizations with our digital toolsCommercialMedicare 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 additions