Encourage Routine Screening to Detect Breast Cancer Early

Breast cancer screening should begin at age 40 and continue every other year until age 74, according to the U.S. Preventive Services Task Force. See tips to close screening gaps.

Review Change in Behavioral Health Benefits Administration for Blue Advantage HMO^SM and MyBlue Health^SM

Effective Jan. 1, 2026, we will administer behavioral health services for these members rather than Magellan Healthcare^®. See how to verify eligibility and benefits and submit claims.

Take Note of End to Benefit Coverage for Viscosupplementation for Osteoarthritis

Viscosupplementation for treatment of osteoarthritis of the hip, knee or any other joint doesn’t meet member benefit certificate coverage criteria. Benefit coverage is ending for most commercial members, effective Jan. 1, 2026.

Review Prior Authorization Changes for Commercial Plans

Effective Oct. 1, 2025, prior authorization requirements for certain commercial plans are changing to reflect new, replaced or removed codes.

Access New Resource on 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 new coding and documentation resource you can use to address potential gaps in care.

Discuss Flu Vaccine Recommendations with Members

The Centers for Disease Control and Prevention recommends an annual vaccine for most people age 6 months and older to help prevent the flu and reduce the risk of potentially serious outcomes.

Ask Members to Complete a Depression Screening

Primary care providers can help members by asking them to complete a screening and encouraging follow-up care with behavioral health care providers when appropriate.

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.

Encourage Members to Adhere to Statin Therapy as Prescribed

We track HEDIS measures on statin therapy for members with cardiovascular disease and diabetes. Review what’s tracked and tips to encourage adherence.

Support Care Coordination After Hospital Discharges

When our members receive inpatient hospital care, hospital care teams can help coordinate care with primary care providers by sharing discharge summaries. Learn how this information can help.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Review and sign up for sessions, including culture of caring training that offers continuing education credit.

Review Guidance on Reporting Allegations of Provider Discrimination Based on Immunization Status

Medicaid providers may not refuse services solely based on a member's refusal or failure to obtain a vaccine. See how to report discrimination allegations to the Texas Health and Human Services Commission.

See Updates to Primary Care Quality Improvement Program

The program rewards providers for exceeding benchmarks for certain quality measures. Learn about the changes for 2026.

Learn About the Transition of Medicaid‑only Acute Care Services to Managed Care

As of Sept. 1, 2025, these services for dual‑eligible members transitioned from fee‑for‑service to managed care. See our FAQs for more details.

Stay Updated on Medicaid News

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

Review Reduced Prior Authorization Response Times for Medicare Members

To ensure timely access to care, we’re adopting Centers for Medicare & Medicaid Services guidelines, effective Jan. 1, 2026. Learn what’s changing.

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.

Commercial Members Rate Health Care Experiences

Through the annual Consumer Assessment of Healthcare Provider and Systems survey, our members in commercial PPO and HMO plans shared their 2024 experiences. Review key survey findings.

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.

Take Note of Changes to Medical Policies

Beginning Oct. 1, 2025, we’re making changes to some medical policies due to updates in utilization management. See what you need to know.

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.