View the latest updates to Medical Clinical Policies
2026
- New to Availity Essentials or looking to sharpen your skills?
- Evolent Prior Authorization Updates Effective October 1, 2026 (PDF)
- Annual Model of Care Training Required
- Updates to Inpatient and Post-Acute Care Pre-and Post-Decision Peer-to-Peer Discussions
- CMS Launches Medicare GLP-1 Bridge Program
- Unbundled Treatment Codes: MH/SUD Providers
- COB Medicare Advantage Commercial OHI
- Optum CPI
- Cotiviti ED Leveling for Facility Services
- Performant Home Health & Skilled Nursing Facility - Audit Program
- Electrodes for TENS Prepay
- Updated Medicare Outpatient Observation Notice Now in Effect
- Non-Exact Duplicate Inpatient Recoveries
- Reminder: Access Toll-Free Fax Numbers at wellcare.com
- Annual Wellness Visit and Routine Physical Exam Coding Refresher
- CareCentrix Medical Necessity Review Criteria Change: Effective May 1, 2026
- Important Prior Authorization Updates: Effective April 1, 2026 (PDF)
- Evolent Prior Authorization Updates: Effective April 1, 2026 (PDF)
2025
- Medicare Telehealth Flexibilities for Wellcare Members through 2026
- CMS Prior Authorization Change: Effective January 1, 2026
- Medicare Prior Authorization Change Summary: Effective October 1, 2025
- Important Prior Authorization updates: Effective October 15, 2025 (PDF)
- Introducing Availity Editing Services
- Model of Care Training Required
- Medicare Prior Authorization Change Summary: Effective 7/1/2025
- Notice of Changes by Medicare That May Affect Drug Coverage
- Medicare Prescription Payment Program
