Encourage Annual Eye Exams for Members with Diabetes

Early detection and treatment can greatly lower the risk of vision loss and eye diseases. See tips to close care gaps and coordinate care.

Review Reminder on Specialist Referrals for Teacher Retirement System Plans

Participants with TRS plans TRS‑ActiveCare Primary or TRS‑ActiveCare Primary+ need a referral from their primary care provider to see most specialists.

Watch for Updates to Availity^® Essentials Claim Status Tool

With November’s updates, you’ll experience consistent tool options with multiple payers when verifying real‑time claim status for members.

Take Note of Paid Claims Editing Enhancements for Medicaid and Medicare Advantage

Beginning in February 2026, we’ll enhance our claims editing and review process for some members to ensure services are properly reimbursed.

Review Prior Authorization Changes for Commercial and Government Plans

Effective Jan. 1, 2026, prior authorization requirements for certain commercial and government plans are changing to reflect new, replaced or removed codes.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. Upcoming sessions include a behavioral health provider webinar on autism spectrum disorder offering continuing education credit. Review options and sign up.

See Updates to Private Duty Nursing Services Benefit Information

Effective for dates of service on or after Nov. 1, 2025, Texas Medicaid updated certain benefit information, including information on prior authorization.

Learn About Continuity of Care for Dual‑Eligible Members

Under the Texas Health and Human Services Commission’s transition of acute care services for dual‑eligible members from fee‑for‑service to managed care, we provide continuity of care for a specific period.

Attend a Medicaid Provider Advisory Group Meeting

Join us for our quarterly meeting in December. We’ll discuss clinical practice guidelines, the Special Beginnings^® program and early relational health. Learn how to register.

Stay Updated on Medicaid News

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

We’re Updating Our Payment Systems to Help Improve Efficiencies

In January, we’ll upgrade our systems to modernize payment processing. These changes will help increase efficiencies and enhance the security of our payment technology.

Verify Your Directory Information Every 90 Days

Our members rely on our provider directory for accurate information about your practice. Review and verify your data every 90 days and update it when it changes.

Review Updates on Managing Your Data in Availity Essentials

The Provider Data Management tool is updated with a new look and more uniform workflow for you to quickly update and verify your information with us. See what’s changed.

See Pharmacy Program Quarterly Update – Part 2

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

See New Coding Policy on Psychiatry and Psychotherapy Services

Effective Dec. 22, 2025, we’ll implement a new Clinical Payment and Coding Policy, CPCP051 Psychiatry/Psychotherapy Services‑Professional Provider, with billing and coding guidance.

Learn About Updates to Clinical Payment and Coding Policies

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

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.