Reinforce Prenatal and Postpartum Care To Support Whole Health

We track quality measures related to our members’ care visits and depression screening during and after pregnancy. Review tips to close gaps in care.

See Our Behavioral Health Resources for Providers

Resources for providers across disciplines include clinical practice guidelines and information on quality measures, as well as introductory webinars offering continuing education credit at no cost to you.

See Prior Authorization Changes for Some Commercial and Government Program Members

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

Watch for Claim Editing Changes for Evaluation and Management Services for Commercial Members

Effective July 1, 2026, we’ll enhance our claims editing and review process for office, inpatient and outpatient evaluation and management services for our members with commercial plans.

Two New Claims Editing Rules To Be Implemented in July 2026

On or after July 8, 2026, we’ll update the Lyric software database to better align provider coding with industry standards for accurate billing and proper reimbursement.

Partner with Us for On‑site Diabetic Retinal Screening Event

Our Quality Improvement Program will bring an event to your practice at no cost for our commercial members who are due for their screening. Learn how to participate.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for training sessions, including a new course on youth behavioral health.

Texas Medicaid and Healthcare Partnership Launches New Online Platform

The IAMOnline platform offers providers an entry point to TMHP applications. See how to register.

Join Us for Electronic Visit Verification Training and Q&A Sessions

Sign up for our free Electronic Visit Verification webinars with question‑and‑answer sessions for Texas Medicaid providers.

Stay Updated on Medicaid News

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

Use Updated Hospital Forms for Medicare Members

The Centers for Medicare & Medicaid Services updated its Important Message from Medicare and Detailed Notice of Discharge. Learn how to access the forms.

Review 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.

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.