Quality Measures Help Track Our 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.

Avoid Inappropriate Use of Antipsychotic Medication 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.

Postponed: Updates to Behavioral Health Substance Use Criteria for Utilization Management

We’ll continue to apply criteria from the American Society of Addiction Medicine’s third edition in our medical necessity reviews for substance use services for adults and adolescents.

Annual Survey Monitors Our Members’ Health Care Experiences

Every year, some of our members receive the Consumer Assessment of Healthcare Providers and Systems survey. It asks them to rate their experiences with their health care providers and plans. Learn about survey topics for Turquoise Care and Medicare Advantage plans.

Earn Continuing Education Credit in Courses on Maternal Mental Health

You can access March of Dimes^® e‑learning modules on maternal mental health and perinatal loss at no cost through May 13, 2025.

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

QMB patients are eligible for both Medicare and Medicaid. If you participate in Blue Cross Medicare Advantage^SM, you may not bill our members enrolled in the QMB program. Learn precautions to take to avoid billing these members.

Hospitals Must Provide Notice to Members Under Outpatient Observation for More Than 24 Hours

Hospitals and critical access hospitals are required to give the standardized Medicare Outpatient Observation Notice to Medicare Advantage plan members who are under outpatient observation for more than 24 hours. The notice explains why the members aren’t inpatient and their cost‑sharing obligations.

Pharmacy Program Quarterly Update – Part 2

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

Revised Policy Requires Appropriate Revenue and Procedure Codes on Outpatient Facility Claims

Effective April 14, 2025, we’ll revise Clinical Payment and Coding Policy CPCP018, which outlines revenue codes that require use of supporting Current Procedural Terminology (CPT^®) and Healthcare Common Procedure Coding System codes and National Drug Codes on outpatient facility claims. Learn what’s changing, including updates to bill types.

Laboratory Management Clinical Payment and Coding Policies Updated

We’ve updated multiple Laboratory Management policies with a new code released by the American Medical Association, effective Jan. 1, 2025.

Clinical Payment and Coding Policy Updates

We regularly add and modify our Clinical Payment and Coding Policies as part of our ongoing policy review. Learn about the policies that were updated.

Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month under the Standards and Requirements tab. 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.

Medicaid Implements Required Taxonomy Code Updates

You must enroll with Medicaid and bill with the correct taxonomy code assigned to your provider type. Learn how to access the updated taxonomy codes.

Learn About Contracting with Turquoise Care

If you’re interested in becoming a provider of Turquoise Care, call 505‑837‑8800 or 800‑567‑8540. Providers participating in our commercial products are not automatically participating providers in Turquoise Care.