Quality Measures Help Track Members’ Heart Health

Heart disease and stroke are among the leading causes of death in the U.S. We track measures related to our members’ blood pressure control and statin therapy. Learn steps to help identify and close care gaps.

Call To Request Preservice Review for Applied Behavior Analysis

Beginning in April 2026, you’ll need to call the customer service number on the member’s ID card to initiate preservice review of applied behavior analysis services for commercial members.

Reminder: Changes to Prior Authorization Programs for Medicare Advantage

As of Jan. 1, 2026, we’re reviewing prior authorization requests for certain care categories that previously were reviewed by EviCore healthcare. Review what’s changed.

Paid Claim Auditing Enhanced for All Members

We’ve enhanced our post pay, claims audit and review process for all our members to help ensure services are properly reimbursed.

Watch for ClaimsXten^TM Update

We’ll implement code updates for the ClaimsXten auditing tool on or after March 16, 2026.

Review Prior Authorization Changes for Some Commercial and Government Plans

Effective Jan. 1, 2026, prior authorization requirements for certain commercial and government plans changed to reflect new, replaced or removed codes.

Avoid the Inappropriate Use of Antipsychotic Medications for Anxiety Disorders

Most antipsychotic medications aren’t approved for the treatment of anxiety disorders. We encourage prescribing providers to carefully assess symptoms, risks and benefits when considering medications for our members with anxiety disorders.

Remind Members About Cervical and Breast Cancer Screenings

Regular screening tests can help detect cancer early when it’s easier to treat. Learn about documenting these screenings in members’ medical records and other tips to close gaps in care.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for sessions.

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.

Annual Survey Measures Members’ Health Care Experiences 

The Consumer Assessment of Healthcare Providers and Systems survey asks a sampling of our Medicare Advantage members to rate their experiences with their health care providers and plans. Learn about survey topics our members may discuss with you.

See Updates to Our Statewide Fee Schedule

The professional provider fee schedules will be updated for certain commercial networks.

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.

Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternative To Be Covered Through Enhanced Prior Authorization

When you submit a prior authorization request for certain drugs with a therapeutic equivalent or alternative, you’ll receive a list of comparable and clinically appropriate preferred drugs, as of Jan. 1, 2026.

Review Pharmacy Program Quarterly Update – Part 2

Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

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.

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.