News and Updates

December 8, 2025	New vendor — Edifecs Clinical Insights (CI) solution informational sessions (PDF)
December 5, 2025	Revised — NaviNet disputes status enhancement (PDF)
December 4, 2025	2026 PerformPlus^® Gaps in Care Closure Program (PDF)
December 2, 2025	Guidance to use the correct payer ID (PDF)
November 24, 2025	Formulary update (January 1, 2026) (PDF)
November 21, 2025	NaviNetdisputes status enhancement (PDF)
November 20, 2025	NaviNet care gap response workflow redesign (PDF)
November 17, 2025	Balance or surprise billing reminders (PDF)
November 5, 2025	Revised: Help us improve member and provider relationships by sharing your demographic and language data (PDF)
November 3, 2025	Tips to avoid timely filing and other common claim denials (November 3 update) (PDF)
October 31, 2025	Provider Manual Revisions (November 2025) (PDF)
October 27, 2025	Maintaining your AmeriHealth Caritas Next provider roster (PDF)
October 26, 2025	Encourage patients to get flu and RSV vaccines (PDF)
October 25, 2025	Updated COVID-19 vaccine guidelines for fall 2025 (PDF)
October 24, 2025	HEDIS follow-up after hospitalization or emergency room — mental health or substance use (PDF)
October 23, 2025	AmeriHealth Caritas NEXT Delaware at a Glance (PDF)
October 22, 2025	HEDIS Measures for Patients with Diabetes (PDF)
October 21, 2025	HEDIS Screening Measures: Breast Cancer, Colorectal Cancer, and Cervical Cancer Screenings (PDF)
October 16, 2025	Beware of phishing scams — don’t take the bait! (PDF)
October 15, 2025	Exchange risk adjustment overview and documentation guidance (PDF)
October 14, 2025	Provider Self-Service through NaviNet (October Update) (PDF)
October 13, 2025	Concomitant Use of CGRP Antagonists (PDF)
October 8, 2025	Help Us Improve Member and Provider Relationships by Sharing Your Demographic and Language Data (PDF)
October 7, 2025	Provider Data Information Form (PDF)
October 6, 2025	Important billing reminder (PDF)
October 2, 2025	Additional Provider Incentive Program (PDF)
October 1, 2025	Organ transplant initial evaluation notification (PDF)
October 1, 2025	Prior authorization changes for select CPT/HCPCS codes (PDF)
September 29, 2025	Care Optimization program — Introducing Edifecs' Clinical Insights (CI) (PDF)
September 24, 2025	Provider Manual Revisions (January 2026) (PDF)
September 24, 2025	Claims and Billing Manual revisions (October 2025) (PDF)
September 12, 2025	Post Appointment Survey Provider Scorecard in NaviNet (PDF)
September 9, 2025	Formulary update (October 15, 2025) (PDF)
September 2, 2025	Guidance to use the correct payer ID (PDF)
August 27, 2025	Prior authorization requests (PDF)
August 19, 2025	Exchange risk adjustment overview and documentation guidance (PDF)
August 18, 2025	Balance or surprise billing reminders (PDF)
August 14, 2025	Can you spot the phish? (PDF)
August 8, 2025	Change Healthcare ConnectCenter^™ Update (PDF)
August 6, 2025	Tips to avoid timely filing and other common claim denials (August 6 Update) (PDF)
August 5, 2025	Access and availability provider alert (PDF)
August 4, 2025	NaviNet Claims Investigation Attachments (PDF)
August 1, 2025	NaviNet claims overpayment recovery response process (PDF)
July 31, 2025	Anesthesia Reimbursement Policy reminder (PDF)
July 30, 2025	Member Reward Card (PDF)
July 29, 2025	Formulary update (September 1, 2025) (PDF)
July 25, 2025	Humira Biosimilars Updates (July 2025) (PDF) Nostrum Laboratories, Inc. Issues Voluntary Nationwide Recall of Sucralfate Tablets USP 1 Gram Within Expiry (PDF)
July 24, 2025	Provider Manual revisions (July 2025) (PDF)
July 23, 2025	Claims and Billing Manual revisions (July 2025) (PDF)
July 21, 2025	HEDIS IET Provider Education Tip Sheet (PDF)
July 14, 2025	Provider self-service through NaviNet (PDF)
July 8, 2025	Provider Data Information Form (PDIF)
July 3, 2025	Important billing reminder (PDF)
June 30, 2025	Risk Adjustment Program — new vendor, UST HealthProof (PDF)
June 27, 2025	Supporting documentation for prior authorization requests (PDF)
June 20, 2025	New vendor to provide in-home health evaluations (IHE) (PDF)
May 29, 2025	Practitioner credentialing rights (PDF)
May 28, 2025	Formulary update (July 15, 2025) (PDF)
May 20, 2025	Save the date — claims overpayment response process (PDF)
May 14, 2025	Participating provider office standards for access and availability (PDF)
May 5, 2025	Tips to avoid timely filing and other common claim denials (PDF)
May 1, 2025	Stelara biosimilar medications (PDF)
April 29, 2025	Blood Pressure Communication Program (PDF)
April 16, 2025	GLP-1 medications (PDF)
April 14, 2025	Provider self-service through NaviNet (April update) (PDF)
April 7, 2025	Provider data information form (PDIF) (PDF)
April 4, 2025	Important billing reminder (PDF)
March 18, 2025	Electronic pharmacy prior authorization (PDF)
March 11, 2025	Formulary updates (April 15, 2025) (PDF)
March 4, 2025	Guidance to use the correct payer ID (PDF)
February 18, 2025	Exchange risk adjustment overview and documentation guidance (PDF)
February 17, 2025	Balance or surprise billing reminders for Delaware Next members (PDF)
February 14, 2025	Additional weekly payments added (PDF)
February 3, 2025	Tips to avoid timely filing and other common claim denials (PDF)
January 31, 2025	2025 PerformPlus^® Gaps in Care Closure Program (PDF)
January 22, 2025	Ways to avoid common errors in electronic prior authorization submissions (PDF)
January 14, 2025	HEDIS advance notice of Palm Quest and Reveleer (PDF)
January 13, 2025	Provider self-service through NaviNet (PDF)
January 6, 2025	Provider Data Information Form (PDIF) January 2025 update (PDF)
January 2, 2025	Important billing reminder for providers (PDF)

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