Learn About Enhancements to Medicaid Utilization Management Process

Effective Sept. 18, 2026, we’re launching Medicaid Authorizations, a new application in Availity^® Essentials that will help streamline the process for submitting and managing utilization management requests for Medicaid members. View details and sign up now for a September webinar.

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.

Take Note of New Reconsideration Filing Limit for Commercial NICU Claims With Ineligible Reason Code of CR1

Beginning Nov. 2, 2026, submit reconsideration requests for commercial neonatal intensive care unit claims assigned a CR1 code within 180 days from the claim finalization date.

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.

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.

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.

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.

Take Note of Provider Reference Manual Updates

Our Medicaid Provider Reference Manual  is updated. Changes to the manual include, but aren’t limited to, the following sections: 3 – Network Services, 6 – Facility and Ancillary Providers, 14 – Pharmacy Services and 16 – Credentialing. 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.

Service‑Rendered Address Required for Gross Receipts Tax Reimbursement

To ensure the GRT is calculated correctly, include the service address on claims with the location at which the services were rendered. See our frequently asked questions for more details.