Watch for Behavioral Health Provider Satisfaction Survey

You’ll be contacted by email or mail if selected to participate. The survey measures your satisfaction with us and identifies areas where we can improve.

See Prior Authorization Changes for Some Commercial and Government Program Members

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

Take Note of Change in Recommended Clinical Review Request Process

Effective Aug. 15, 2026, we’re retiring the recommended clinical review request process through the Availity^® Essentials Attachments tool. You may continue to submit requests online through Availity Authorizations and by fax and phone.

Encourage Routine Vaccines and Well‑Care Visits for Children and Adolescents

We track quality measures on immunizations for adolescents and preventive care visits for members ages 3 to 21. See tips to close care gaps.

Avoid Antibiotics for Acute Bronchitis and Other Viruses

With back‑to‑school season approaching, consider talking with our members about taking antibiotics only when needed. See alternatives to antibiotics and information to share.

Discuss Preventive Care With Members

To reduce the risk of problems or catch them early, consider encouraging our members to seek preventive care, when appropriate. Review tips and preventive care guidelines.

Explore Learning Opportunities

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

Review PEAQ^SM Methodology Updates for 2026

The updated methodology for our Provider Efficiency, Appropriateness, & Quality^SM program is now available. This methodology explains how PEAQ evaluates provider performance.

Watch for Outreach on Provider Directory Information

As part of our annual provider directory audit, you may be contacted by vendor Press Ganey to verify your information. Please respond promptly if contacted.

Review Pharmacy Program Quarterly Updates – Part 2

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.

Take Note of Provider Reference Manual Updates

Our Medicaid Provider Reference Manual has been updated. Changes to the manual include, but aren’t limited to, the following section: 7 – Selection and Retention of Participating Providers. Please review it for all changes.

MTM Health To Provide Medical Transportation for Medicaid Members

We’ll transition from Modivcare to MTM Health as the sole provider of nonemergency medical transportation for our members with Medicaid coverage, effective Nov. 1, 2026.

Talk With Members About Access to Contraceptive Care

We track U.S. Department of Health and Human Services quality measures on contraceptive care for Turquoise Care members. Learn what data is measured.