Watch for Our Provider Availability and Access Survey

Your response helps ensure compliance with wait time standards for primary care, specialty and behavioral health services.

Postponed: Enhanced Claim Review for Oncology Drugs and Services

We’re delaying the enhancement of our claims editing and review process of some oncology drugs and services for our Medicare Advantage and Medicaid members.

Use Simplified Referral Form for American Indian and Alaska Native Limited Cost‑Share Plans

We’ve streamlined the claims referral form that Indian Health, Tribal and Urban Indian providers use to refer members of limited cost‑sharing plans to non‑I/T/U providers. Learn what’s changed.

ClaimsXten^TM Update

We’ll implement code updates for the ClaimsXten auditing tool on or after Aug. 18, 2025.

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.

See Updates to Clinical Practice and Preventive Care Guidelines

The guidelines are based on established evidence‑based standards and support decision‑making processes in member care.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. Sign up for sessions, including training on coding for major depressive disorder.

Medicaid Covers Rentals of Dual‑Function Home Ventilators

As of April 1, 2025, procedure code E0468, rentals of dual‑function home ventilators, is a benefit of Texas Medicaid.

Rider 32 to Transition Medicaid‑Only Services for Dual‑Eligible Members

Effective Sept. 1, 2025, you’ll be able to bill us directly for Medicaid wrap‑around services for dual‑eligible members.

Sarepta Suspends ELEVIDYS for Non‑Ambulatory Patients

Providers should halt administration of the drug for non‑ambulatory patients with Duchenne muscular dystrophy.

Report Potential Quality of Care Concerns

We investigate potential quality of care complaints and deficiencies in clinical care. Learn how to submit concerns and reports of abuse.

Stay Updated on Medicaid News

You can find information for STAR, STAR Kids and CHIP in Medicaid News and Updates.

Code Effectively to Earn Additional Incentive Payments on Medicare Advantage Claims

Participating providers in our Medicare Advantage networks can earn an additional incentive payment when submitting claims with certain codes. See our updated list for details and incentive amounts.

Encourage Medicare Members to Respond to Health Outcomes Survey

The Centers for Medicare & Medicaid Services surveys a sample of our members to rate their care. Learn about survey topics our members may discuss with you.

Review Rights and Responsibilities

As a participating provider, you have certain rights and responsibilities that may affect your practice. Learn more about your rights and responsibilities and those of our members.

Learn About Updates to Clinical Payment and Coding Policies

We regularly add and modify our CPCPs as part of our ongoing policy review. See which policies were updated and when.

Review 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. 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.