Quality Measures Track Treatment and Follow‑Up Visits for Substance Use Disorders

You can play an important role in our members’ care by discussing the signs of substance use disorders and encouraging getting help, if appropriate. Review tips to close care gaps.

Watch for Requests for Behavioral Health Documentation for Medicaid Members

Medical record documentation standards and reviews help ensure quality care. Learn what information may be requested or reviewed through electronic health records.

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.

Access Resource on 2026 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 coding and documentation resource to help address potential gaps in care.

Explore Learning Opportunities

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

Use Updated Medicare Outpatient Observation Notice

The Centers for Medicare & Medicaid Services updated the notice that hospitals and critical access hospitals are required to give Medicare Advantage plan members who are under outpatient observation for more than 24 hours. Learn how to access the notice.

Keep Your Record ID Active To Prevent Network Termination

If you haven’t filed a claim with your billing or rendering National Provider Identifier and Tax ID Number with a date of service within 24 months, we may cancel your corresponding record ID, and you may be terminated from our networks. Learn how to keep your record ID active with us.

See How To Request Help on Certain BlueCard^® Claims

For claims issues that meet specific criteria, you may reach out to our BlueCard Executive for assistance. Learn which providers and claims are eligible.

Take Note of Provider Reference Manual Updates

Our Provider Reference Manual  is updated, effective March 12, 2026. Changes to the manual include, but aren’t limited to, the following section: 15 – Provider Service Inquiry and Grievance Process. Please review it for all changes.

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.

Turquoise Care Transitions to New Claims System

Turquoise Claims launched on March 23, 2026. It replaces Omnicaid and the New Mexico Medicaid Portal.