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

NaviNet disputes 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 abuse (PDF)

October 22, 2025

HEDIS Measure 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 (PDF)

October 15, 2025

Exchange risk adjustment overview and documentation guidance (PDF)

October 14, 2025

Provider Self-Service through NaviNet (PDF)

October 13, 2025

Concomitant use of CGRP antagonists (PDF)

October 10, 2025

Important Laboratory Reminder for In-Network Providers (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 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 26, 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 (PDF)

August 5, 2025

Participating provider office standards for access and availability (PDF)

August 4, 2025

NaviNet Claims Investigation Attachments (PDF)

August 1, 2025

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 (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 (July update) (PDF)

July 11, 2025

Reminder to direct members to AmeriHealth Caritas Next participating labs (PDF)

July 8, 2025

Provider Data Information Form (PDIF) (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)

June 9, 2025

Guidance to use the correct payer ID (PDF)

May 29, 2025

Practitioner Credentialing Rights (PDF)

May 28, 2025

Formulary updates (July 15, 2025) (PDF)

May 23, 2025

Reminder to direct members to AmeriHealth Caritas Next participating labs (PDF)

May 20, 2025

Save the date — claims overpayment response process improvements (PDF)

May 19, 2025

Balance or surprise billing reminders (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)

March 25, 2025

Provider Manual revisions (March 2025) (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 Florida 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 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)

December 20, 2024

275 claim attachment transactions update (PDF)

December 12, 2024

Participating provider office standards for access and availability (PDF)

December 3, 2024

Use the correct payer ID when filing claims (December Reminder) (PDF)

November 26, 2024

Formulary update (January 1, 2025) (PDF)

November 21, 2024

Restoration of Optum/Change Healthcare connectivity (PDF)

October 28, 2024

Introduction to Optum’s “Prospective Inpatient Claim Review” and “Credit Balance Review” programs (PDF)

October 25, 2024

Provider Manual revisions (January 2025) (PDF)

October 24, 2024

Provider information security awareness (PDF)

October 24, 2024

Reminder: Use of modifiers for physical, occupational, and speech therapy and physical rehabilitation (PDF)

October 15, 2024

CPT CAT II code incentive program (PDF)

October 11, 2024

Provider satisfaction survey reminder (PDF)

October 7, 2024

Attestation requirement: Provider Data Information Form (PDF)

October 4, 2024

PerformPlus® Gaps in Care Closure Program (PDF)

October 2, 2024

Pfizer voluntarily withdraws all lots of sickle cell disease treatment Oxbryta® (voxelotor) from worldwide markets (PDF)

September 16, 2024

Kidney and eye health evaluation for patients with diabetes (PDF)

September 11, 2024

Population Health program/coordination of medical care (PDF)

September 9, 2024

275 claim attachment transaction is now available via Availity (PDF)

September 6, 2024

Reminder to use the Provider Appeal Form available on our website (PDF)

September 5, 2024

Formulary update (November 1, 2024) (PDF)

September 3, 2024

Reminder to use the correct payer ID when filing claims (PDF)

August 22, 2024

Lab test billing reminder (PDF)

August 16, 2024

Provider manual revisions (August 2024) (PDF)

August 13, 2024

Balance or surprise billing reminders for Florida Next members (PDF)

July 29, 2024

Exchange Risk Adjustment Overview and Documentation Guidance (PDF)

July 26, 2024

Change Healthcare ConnectCenter™ Update (PDF)

July 15, 2024

Prior Authorization Requirement Changes (PDF)

July 3, 2024

Formulary update (August 1, 2024) (PDF)

July 1, 2024

Provider Data Information Form (PDF)

June 12, 2024

Reminder to Use the Correct Payer ID When Filing Claims (PDF)

June 7, 2024

Reminder to Direct Members to AmeriHealth Caritas Next Participating Labs (PDF)

May 31, 2024

No-Cost Smoking Cessation Therapy (PDF)

May 16, 2024

Remittance Advice Payment Recovery Details Now Available! (PDF)

May 3, 2024

Change Healthcare Restoration of Services Status (PDF)

April 19, 2024

Breast Cancer Screening of Women With Schizophrenia — An Opportunity for Improvement (PDF)

April 15, 2024

National Imaging Associates is becoming Evolent (PDF)

April 12, 2024

Provider Data Information Form (PDF)

April 9, 2024

Prior Authorization Guidelines Tip Sheet: ADHD Medications (PDF)

April 5, 2024

Formulary update (May 1, 2024) (PDF)

March 25, 2024

Claims Timely Filing Deadline Extension (PDF)

March 25, 2024

Electronic Remittance Advice (ERA/835) Access (PDF)

March 21, 2024

Availity Additional Information Provider Notice (PDF)

March 8, 2024

Claim Submission Options Update (PDF)

March 6, 2024

Alternative Claim Submission Option Available (PDF)

February 12, 2024

Healthcare Effectiveness Data and Information Set (HEDIS®) (PDF)

January 3, 2024

Use the correct plan payer ID when filing claims (PDF)

December 6, 2023

Formulary update (January 1, 2024) (PDF)

November 30, 2023

Prior authorization requirement changes for select procedure/HCPCS codes (PDF)

November 28, 2023

Lab test billing reminder (PDF)

November 3, 2023

Provider satisfaction survey reminder (PDF)

November 3, 2023

PerformPlus® Gaps in Care Closure program (PDF)

October 12, 2023

Prior authorization request reminder (PDF)

October 9, 2023

Use of AT modifier for chiropractic care (PDF)

September 26, 2023

Formulary update (September and October 2023) (PDF)

August 17, 2023

Formulary update (September 5, 2023) (PDF)

August 4, 2023

Submission of electronic documentation (275 Transactions) (PDF)

August 1, 2023

Updated practitioner credentialing rights (PDF)

July 26, 2023

Use of modifiers for physical, occupational, and speech therapy, and physical rehab (PDF)

July 26, 2023

Use of modifiers for chiropractic care (PDF)

July 25, 2023

Care Gaps that can be closed in NaviNet (PDF)

July 18, 2023

Provider Data Information Form (PDIF) attestation instructions (PDF)

July 17, 2023

Formulary update (August 1, 2023) (PDF)

June 26, 2023

EDI compliance upgrade to SNIP Level 4 effective July 20, 2023 (PDF)

May 9, 2023

Akorn issues voluntary nationwide recall of various human and animal drug products within expiry due to company shutdown (PDF)

April 20, 2023

FDA Commissioner and Chief Scientist announce decision to withdraw approval of Makena (PDF)

April 15, 2023

Pharmacy formulary update (May 15, 2023) (PDF)