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.

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.

New Claim Editing Rules To Be Implemented

On or after Dec. 1, 2026, we’ll update the Lyric software database to better align provider coding with industry standards. See what’s changing.

See Prior Authorization Changes for Some Commercial Members

We’ve updated prior authorization requirements for some commercial members to reflect new, replaced or removed codes.

Discuss Flu Shots and Other Vaccines With Members

With flu season approaching, we encourage you to talk with our members about vaccines that can reduce the risk of illnesses and potentially serious outcomes.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for sessions, including a webinar on perinatal mental health.

View PEAQ^SM Provider Performance Insights Reports

PPI reports for the Provider Efficiency, Appropriateness, & Quality^SM program are ready for eligible providers to access online.

Verify Your Directory Information Every 90 Days

Our members and other providers rely on our provider directory for accurate information about your practice. Contracted providers’ directory data must be verified at least every 90 days, even if it hasn’t changed.

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

Contact Your Provider Relations Representative

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

Review Pharmacy Program Quarterly Updates — Part 1

We’ve made changes 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.