PEAQ^SM Physician Performance Insight Reports Are Now Available

Physician Performance Insight reports for our Physician Efficiency, Appropriateness, & Quality^SM program are ready for eligible Illinois physicians to access online.

Learn About Change to Laboratory Benefit Management Program

Beginning Jan. 1, 2026, our claims review program will apply to certain Administrative Services Only members’ claims. See what types of claims are eligible for review.

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 and Government Plans

Effective Oct. 1, 2025, prior authorization requirements for certain commercial and government 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.

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.

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. Review screening tools and tips.

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. View the schedule and sign up for sessions, including culture of caring training that offers continuing education credit.

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.

See the Latest Pharmacy Prior Authorization Changes

We’re updating our standard pharmacy prior authorization programs. Changes affect members with prescription drug benefits administered by Prime Therapeutics^®. Review what’s changing as of Nov. 1, 2025.

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 Following the Illinois Health Care Protection Act

Beginning Oct. 1, 2025, we’re changing some medical policies following guidance from the Illinois Health Care Protection Act. 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.