We’re finishing up some key implementation steps to support our provider portal transition. Please be sure your organization is registered for Availity Essentials so your teams can get familiar with how everything works.
Note: Your billing company can also get an account.
Important updates effective April 1
Specific documentation for ABA prior authorization requests: Starting April 1, all applied behavioral analysis (ABA) prior authorization requests must include documentation supporting the MCG policy we use (Applied Behavioral Analysis, B-806-T, 29th Edition). This will help us process your request quickly and avoid delays in care. See an overview and tips on what to include.
Note:Claims for ABA services are paid based on the approved weekly unit count that was authorized for each code to support medical necessity (not a cumulative number of units across the entire authorization period).
Claim pricing update: To better align with industry standards, the following update will be effective for service dates on or after April 1.
Radiopharmaceuticals and contrast agents: Non-therapeutic radiopharmaceuticals and contrast agents administered during an imaging procedure or certain nuclear medicine procedures rendered in a facility setting will be included in the reimbursement for the associated service. See the updated Included Services list.
Update to the 2026 Part B step therapy policy: The recently revised 2026 Part B step therapy list reflects these updates, effective April 1:
•
Denosumab: Added Enoby™ and Xtrenbo™ to the step 2 (non-preferred) list of biosimilars.
•
Myasthenia gravis: Relaxed the step therapy requirements for certain medications and diagnoses.
Quarterly drug fee updates: You can preview the April 1 updates starting March 1 on the Availity Essentials portal. Read more.
Reminders
90-day window for standard timely filing: For claims with service dates on or after January 1, 2026, our standard timely filing time frame is 90 days from the date of service.
Incident-to billing requirements: See our revised policy.
Prefixes matter: When entering a member ID to check eligibility, claims, or prior authorization, be sure to use the correct prefix for the date of service. If you get an error message, you can access the recently updated prefix list or prefix replacement list to see if the prefix has been replaced. For more information about prefix replacements, visit azblue.com/prefix.
Planning to drop by? We’re here for you and happy to help, but we’re not always in the office or available for a quick hello or spontaneous meeting. Please let your Provider Relations Contact know in advance!
Feel free to contact us if you have questions: 844-995-2583.
02/24/2026
Availity is a separate, independent company contracted with AZ Blue for provider portal services. Availity is a registered service mark and Availity Essentials is a service mark of Availity, LLC.
The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, part of the Hearst Health network.
Enoby and Xtrenbo are trademarks of Hikma Pharmaceuticals USA Inc.
Blue Cross, Blue Shield, the Cross and Shield Symbols, Federal Employee Program, and FEP are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
