PEAQ^SM Physician Performance Insight Reports Are Now Available

Physician Performance Insight reports for our Physician Efficiency, Appropriateness, & Quality^SM program are ready for eligible Oklahoma physicians to access online.

Learn About Change to Laboratory Benefit Management Program

Beginning Jan. 1, 2026, our claims review program will apply to certain Administrative Services Only members’ claims. See what types of claims are eligible for review.

Take Note of End to Benefit Coverage for Viscosupplementation for Osteoarthritis

Viscosupplementation for treatment of osteoarthritis of the hip, knee or any other joint doesn’t meet member benefit certificate coverage criteria. Benefit coverage is ending for most commercial members, effective Jan. 1, 2026.

Review Prior Authorization Changes for Commercial Plans

Effective Oct. 1, 2025, prior authorization requirements for certain commercial plans are changing to reflect new, replaced or removed codes.

Access New Resource on Quality Measures in Availity^® Essentials

We use Healthcare Effectiveness Data and Information Set (HEDIS^®) measures to help ensure our members get the services they need. Learn about a new coding and documentation resource you can use to address potential gaps in care.

Encourage Routine Screening to Detect Breast Cancer Early

Breast cancer screening should begin at age 40 and continue every other year until age 74, according to the U.S. Preventive Services Task Force. See tips to close screening gaps.

Discuss Flu Vaccine Recommendations with Members

The Centers for Disease Control and Prevention recommends an annual vaccine for most people age 6 months and older to help prevent the flu and reduce the risk of potentially serious outcomes.

Ask Members to Complete a Depression Screening

Primary care providers can help members by asking them to complete a screening and encouraging follow-up care with behavioral health care providers when appropriate. Review screening tools and tips.

Consider Behavioral Health Evaluations During Hospital Stays

To help improve health outcomes for members receiving inpatient care, we encourage hospital staff and attending providers to consider behavioral health evaluations and follow‑up care coordination when appropriate.

Encourage Members to Adhere to Statin Therapy as Prescribed

We track HEDIS measures on statin therapy for members with cardiovascular disease and diabetes. Review what’s tracked and tips to encourage adherence.

Support Care Coordination After Hospital Discharges

When our members receive inpatient hospital care, hospital care teams can help coordinate care with primary care providers by sharing discharge summaries. Learn how this information can help.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Review and sign up for sessions, including culture of caring training that offers continuing education credit.

Review Reduced Prior Authorization Response Times for Medicare Members

To ensure timely access to care, we’re adopting Centers for Medicare & Medicaid Services guidelines, effective Jan. 1, 2026. Learn what’s changing.

Look for Your Medicare Advantage Access and Availability Survey

This brief biannual survey on appointment wait times supports network accessibility for our members. If you’re selected to participate, we’ll email you the survey this month.

Learn What Members Say They Want from Their Health Care Professionals

Our surveys give insights that may benefit your interactions with our members. Learn about their feedback.

Looking for Help?

Do you know the fastest way to get a response on prior authorizations? Are you aware of the latest pharmacy drug updates, or do you have a claims question? You can find many answers on our provider website, including:

• The latest updates

• Details about tools to streamline billing and processes

• Tips for newly contracted providers

• Quick reference links

Contact Your Provider Relations Representative

If you have a question and can’t find an answer, our provider relations representatives are here to help. Email us or call 800‑722‑3730 and select Option 2 for network.

Learn About Updates to Clinical Payment and Coding Policies

We regularly add and modify CPCPs as part of our ongoing policy review. See which policies were updated and when.

Take Note of Changes to Medical Policies

Beginning Oct. 1, 2025, we’re changing some medical policies due to updates in utilization management. See what you need to know.

Review Active and Pending Medical Policies

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.