Key Updates
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 23, 2025
Enhance care provider data accuracy with updated roster tools
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Benefits of utilization management attestations: a guide for care providers
BadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Earn CME credits: Attend our engaging webinars
Recent Updates
Medicare AdvantageJuly 25, 2025
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 28, 2025
BadgerCare Plus and Medicaid SSI ProgramsJuly 25, 2025
Precertification/prior authorization requirement changesEffective September 1, 2025
CommercialJuly 24, 2025
Specialty pharmacy updates — August 2025CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 23, 2025
Enhance care provider data accuracy with updated roster toolsCommercialJuly 22, 2025
July formulary deletionsMedicare AdvantageJuly 21, 2025
Anthem Medicare Advantage Group Retiree Quick Reference GuideCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 18, 2025
New mandatory fields in roster templateBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Clinical Criteria updatesEffective August 3, 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Benefits of utilization management attestations: a guide for care providersCommercialJuly 1, 2025
Reimbursement policy update: Bundled Services and Supplies — ProfessionalMedicare AdvantageJuly 1, 2025
Implementation of chargemaster‑based claims edit for ER levelingCommercialJuly 1, 2025
A quick guide to understanding JW and JZ modifiersMedicare AdvantageJuly 1, 2025
A quick guide to understanding JW and JZ modifiersCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Seamless Provider Enrollment and Network Management through Availity Essentials optimizes the care provider experienceCommercialJuly 1, 2025
Enroll with Availity to verify your provider dataCommercialJuly 1, 2025
Update: essential ICD‑10‑CM compliance for outpatient facility claimsBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Earn CME credits: Attend our engaging webinarsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Streamlining behavioral health authorizations via Availity EssentialsMedicare AdvantageJuly 1, 2025
Combat diabetes: Close the statin therapy gap for better heart healthCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
Join the 2025 Clinical Quality in Practice webinar seriesCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2025
National Drug Codes (NDCs) are required for professional and outpatient claimsMedicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expandedEffective November 1, 2025
Axtle, Bizengri, and Bynfezia pen
CommercialJune 25, 2025
Medical Policies and Clinical Guidelines updates — August 2025Medicare AdvantageJune 23, 2025
Essential information for providers: understanding Medicare Advantage group retiree plansCommercialBadgerCare Plus and Medicaid SSI ProgramsJune 17, 2025
National Drug Code required for professional and facility outpatient claimsMedicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updatesBadgerCare Plus and Medicaid SSI ProgramsJune 13, 2025
Precertification/prior authorization requirement changesEffective August 1, 2025
Medicare AdvantageJune 3, 2025
Precertification/prior authorization requirement changesEffective November 1, 2025
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 3, 2025
National Drug Codes (NDC) are required for outpatient claimsCommercialJune 2, 2025
Specialty pharmacy updates: June 2025CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Registration is now available for our upcoming CME webinar on Integrating Cancer CareBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Navigating health with confidence through the Complex Case Management programBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Learn about members’ rights and responsibilitiesBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Utilization management: prioritizing appropriate care and transparencyCommercialJune 1, 2025
Update to claims system for global surgical procedures for professional providersCommercialJune 1, 2025
You are invited: claims appeals on Availity EssentialsCommercialJune 1, 2025
Updated 2025 provider manual now availableMedicare AdvantageJune 1, 2025
Bridging the gap: enhancing medication adherence for better health outcomesCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJune 1, 2025
Submitting BH authorizations in Availity EssentialsMedicare AdvantageJune 1, 2025
Claims guidance: updating inpatient and outpatient bill typesCommercialJune 1, 2025
Availity Essentials Provider Overpayments application launchCommercialMedicare AdvantageJune 1, 2025
LabCorp and Quest Diagnostics are in-network — reminderCommercialJune 1, 2025
Prior authorization for NICU services: Clinical UM Guideline availableCommercialJune 1, 2025
Unlock updated pharmacy insights today — visit our provider websiteCommercialMay 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 plans