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.

We’ll Conduct Coordination of Benefit Reviews for Medicaid Claims To Identify Potential Overlaps in Coverage

Effective Nov. 1, 2026, we’ll work with Machinify to conduct coordination of benefit reviews to identify potential overlaps in coverage affecting accurate claim payments.

Update: Viscosupplementation for Osteoarthritis Is a Covered Benefit for ERS Members

Viscosupplementation for treatment of osteoarthritis of the hip, knee or any other joint may meet member benefit certificate coverage criteria for Employees Retirement System of Texas members.

Take Note of 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.

MTM Health To Provide Medical Transportation for Medicaid Members

We’ll transition from Modivcare to MTM Health for nonemergency medical transportation for our members with Medicaid coverage, effective Oct. 1, 2026.

Access New Applications in TMHP IAMOnline

Effective Aug. 24, 2026, Texas Medicaid & Healthcare Partnership added applications to the TMHP IAMOnline platform. View reminders on account activation and which applications were transitioned.

Stay Updated on Medicaid News

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

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.

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.