Reinforce Prenatal and Postpartum Care To Support Whole Health

We track quality measures related to our members’ care visits and depression screening during and after pregnancy. Review tips to close gaps in care.

See Our Behavioral Health Resources for Providers

Resources for providers across disciplines include clinical practice guidelines and information on quality measures, as well as introductory webinars offering continuing education credit at no cost to you.

See Prior Authorization Changes for Some Commercial and Government Program Members

We’ve updated prior authorization requirements for certain commercial and government plans to reflect new, replaced or removed codes.

Watch for Claim Editing Changes for Evaluation and Management Services for Commercial Members

Effective July 1, 2026, we’ll enhance our claims editing and review process for office, inpatient and outpatient evaluation and management services for our members with commercial plans.

Two New Claims Editing Rules To Be Implemented in July 2026

On or after July 8, 2026, we’ll update the Lyric software database to better align provider coding with industry standards for accurate billing and proper reimbursement.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for training sessions, including a new course on youth behavioral health.

Use Updated Hospital Forms for Medicare Members

The Centers for Medicare & Medicaid Services updated its Important Message from Medicare and Detailed Notice of Discharge. Learn how to access the forms.

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.

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 Reimbursement Policies

We regularly add and modify reimbursement policies, formerly known as clinical payment and coding policies, 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.