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.

Behavioral Health Documentation to Be Reviewed for Medicaid Members

Medical record documentation standards help ensure quality care. Learn what information may be requested or reviewed through electronic health records.

Take Note of Prior Authorization Changes for Commercial and Government Programs

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

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. View the schedule and sign up for sessions, including a claims overview and training on coding.

Verify Provider Information by Roster Every 90 Days to Fulfill Auditing Requirements

We now require commercial provider groups to submit a roster at least once every quarter. Commercial solo professional providers are encouraged to submit rosters to meet the verification requirement. This will allow us to reduce calls to your office while supporting commercial and Qualified Health Plan directory audits required by state law. Learn about the roster process.

Review Prior Authorization Changes

We’re making updates to our standard pharmacy prior authorization programs. Changes affect members with prescription drug benefits administered by Prime Therapeutics. Learn what’s changing, effective June 2025.

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 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.