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Black Maternal Health Week, April 11-17, is an opportunity to raise awareness about specific health challenges and the importance of addressing disparities in care to improve the health of Black mothers and their babies.

According to the Commonwealth Fund, the U.S. has some of the worst maternal and infant health outcomes among high-income countries, and people of color are disproportionally affected. Black Maternal Health week was developed to raise awareness and increase advocacy around this health disparity. That's why we’re committed to addressing maternal health disparities, so everyone has the same opportunity to have a healthy pregnancy and baby.

Collaborating across the care team

Impacting health inequities requires focused collaboration across the health system. We are collaborating with providers to take a more comprehensive approach to maternity care through alternative payment models. Our latest maternity payment model will examine the total related care a member receives during all phases of prenatal care, through delivery and the postpartum journey, as well as the first months of the baby’s life.

We encourage providers to support preventive and patient-centered experiences by embedding health equity quality measures in their practice and incentivizing the proactive reduction of health disparities.

Managing risks during pregnancy
Research shows that Black women experience serious complications at consistently higher rates than white women, regardless of age or income. To help lower these risks, our Bump2Baby program includes equity-centered support and resources for members during and after their pregnancy. This includes:

• Screening members for social risk and connecting them to necessary resources
• Factoring in social drivers of health in identifying high-risk pregnancies
• Reaching out to members with high-risk pregnancies to offer care management
• Training our care managers to help members navigate concerns around maternal health inequities and discrimination
• Educational resources for members about maternal health, disparities, warning signs of complications and more.

This program fosters a close partnership between care managers and members to integrate whole-person health while supporting the care you provide.

Addressing postpartum care needs
Quality care is just as critical postpartum. Severe complications can happen during this time, with nearly one-third of maternal deaths occurring one week to one year after childbirth. For many new mothers, this period is a fragile balance of physical and mental recovery from giving birth, while adjusting to parenthood and navigating new dynamics with their baby—such as lactation and sleep.

An analysis of our claims data found that postpartum provider visit rates are low, especially for Black and Hispanic/Latinx members. We encourage you to ensure postpartum visits are completed so members receive the support they need when they need it most.

Helping members have the healthiest pregnancy possible
Our members have access to convenient, digital tools to support their maternity journey. Our Bump2Baby program provides personalized support from nurse care managers. Bump2Baby is embedded in fully insured plans and available as a buy-up option for Asuris administrative services only groups.

Together, we can create meaningful change. Every mother deserves the opportunity for a healthy pregnancy and a healthy baby, and your role is crucial in making this vision a reality. Let's work together to ensure that Black Maternal Health Week isn't just about awareness, but about concrete action toward better outcomes for all mothers receiving care.

4/8/2025

Freestanding imaging facilities need to register with OptiNet prior to the site-of-care reviews that begin May 1, 2025.

OptiNet collects service and capability information about outpatient providers, which Carelon Medical Benefits Management (Carelon) will use to determine available sites for MRIs and CTs for our commercial members.

To learn more about the radiology site-of-care program, using the Carelon provider portal and registering with OptiNet, register for a Carelon webinar.

4/1/2025

The code-specific lookup feature for reimbursement schedules is unavailable. While we work to restore this function, please follow these steps to access reimbursement information:

1. Access the Fee Schedule Tool through Availity Essentials
2. Enter your National Provider Identifier (NPI) or tax ID
3. Click the Actions button
4. Select Download entire fee schedule

Note: The Enter Specific Codes function is unavailable. You must download the complete reimbursement schedule to view rates.

We are working with our vendor to restore the code lookup feature and will announce when it is available.

3/13/2025

Availity is currently unable to accept appeals for emergency department (ED) claims reviewed and adjusted as part of our Emergency Department Claim (EDC) Analyzer program with Optum.

Affected claims will have an N22 Alert that states the procedure code was added/changed because it more accurately describes the services rendered.

Industry-wide supply constraints have led Walgreens to limit the amount of GLP-1 medications they'll dispense. They will only dispense one-month supplies of GLP-1 medications in most cases.

Please inform your patients of these restrictions or guide them to alternative in-network pharmacies when needed.

What’s happening with the GLP-1 shortage?

The FDA announced that the GLP-1 medication tirzepatide injection, used to treat type 2 diabetes, is no longer in shortage. But several other GLP-1 products remain in short supply. GLP-1 manufacturers Novo Nordisk and Eli Lilly have invested heavily in expanding their manufacturing capabilities to ease shortages in the coming months.

Express Scripts (ESI) home delivery pharmacy suspended dispensing GLP-1 drugs for members who are new to therapy (NTT) in December 2024. As of February 1, 2025, they have resumed dispensing these medications for NTT members.

2/11/2025