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Provider News & Information

Subscribe To Superior's Provider Newsflash

Don't miss important provider news and updates! Superior's Provider Newsflash is an e-newsletter emailed every two weeks to subscribing providers. Providers can receive customized news updates from Superior relevant to their region, specialty or Superior products.

Customized news may include, but is not limited to:

  • Mandatory trainings
  • Billing and claims information
  • Texas Health and Human Services (HHS) requirements
  • Superior policy updates

Provider Newsflash June 4, 2024

  • ACCESS: Online Provider Toolkits
  • UPDATED: Provider Statement of Need Form
  • REQUIRED: 3 in 30 for Your Patients
  • Care Management Program Benefits
  • Provider Trainings & Special Events
  • Effective May 22, 2024: Clinical Policies
  • Effective May 27, 2024: Clinical Policies
  • Effective June 1, 2024: Pharmacy and Biopharmacy Policies
  • Effective June 1, 2024: Revised Payment Policy: Code Editing Overview
  • Effective June 28, 2024: Clinical Policies
  • Effective July 31, 2024: Clinical Policies
  • Effective August 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash May 21, 2024

  • JOIN US: Provider Advisory Groups
  • Asthma Awareness Month
  • Secure Portal: Manage Tasks Quickly and Easily
  • Provider Credentialing Information and Rights
  • ACTION REQUIRED: Confirm Your Information

Provider Newsflash May 7, 2024

  • Effective 5/1: Prior Authorization Update
  • Preferred Specialty Pharmacy Information
  • Trainings for Hospital Providers
  • Do Your Patients Understand Their Rights and Responsibilities?
  • EVV Alternative Device Phase-Out
  • Effective July 1, 2024: Pharmacy and Biopharmacy Policies
  • Effective August 1, 2024: Clinical Policies

Provider Newsflash April 23, 2024

  • Claims Submission and Payment Updates
  • Billing EVV Services as Secondary Insurance Claims
  • PROHIBITED: Balance Billing
  • Upcoming Recruitment and Retention Webinar
  • HHS Briefing on Change Healthcare
  • Effective May 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash April 9, 2024

  • NEW: Behavioral Health Appointment Platform
  • Health Passport Requirements for Behavioral Health Providers
  • April 27: Drug Take Back Day
  • Access Behavioral Health Tools and Resources
  • Cervical Cancer: Prevention Recommendations and Guidelines

Provider Newsflash March 26, 2024

  • Effective 4/15: Cranial Molding Orthosis
  • CLAIMS: Unmatched EVV Denials
  • Secure Portal: Manage Tasks Quickly and Easily
  • STAR+PLUS: Contract Award Updates
  • Members Rate Their Provider Experience
  • Effective March 25, 2024: Clinical Policies
  • Effective April 1, 2024: Pharmacy and Biopharmacy Policies
  • Effective May 31, 2024: Clinical Policies
  • Effective June 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash March 12, 2024

  • BILLING: Availity Webinars Available
  • Training Requirement: Model of Care
  • 3 in 30 Assessments for Your Patients
  • REQUIRED: Appointment and Office Site Standards
  • Superior Celebrating 25th Anniversary
  • Effective January 1, 2024: Retired Medicare Clinical and Clinical Payment Policies
  • Effective June 1, 2024: New Clinical Payment Policies: Infectious Disease - Lab Screening and Testing

Provider Newsflash February 27, 2024

  • Change Healthcare Provider Alert
  • Effective 3/1: Prior Authorization Update
  • Help Protect Your Patients Against RSV
  • UPDATED: Preferred Drug List
  • Upcoming Hepatitis C Educational Webinar
  • Apply Now: Home Health Aide Training Program
  • Effective March 1, 2024: Pharmacy and Biopharmacy Policies
  • Effective May 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash January 30, 2024

  • PRIOR AUTH: Coverage Changes for Certain Drugs
  • Ambetter Provider Training
  • Support for Members Affected by Severe Weather
  • REQUIRED: Is Your Information Accurate?
  • Provider Trainings Available 
  • Effective January 22, 2024: Clinical Policies
  • Effective February 1, 2024: Pharmacy and Biopharmacy Policies
  • Effective March 29, 2024: Clinical Policies
  • Effective April 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash January 16, 2024

  • 2024 Formulary Changes
  • REQUIREMENTS: Missing EVV Visits and New TAC Rules
  • PROHIBITED: Balance Billing
  • Health Passport Requirements
  • Connecting with the Direct Care Workforce
  • Effective March 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash December 19, 2023

  • 3 in 30 Assessments
  • Secure Portal: Manage Tasks Quickly and Easily
  • Training Requirement: Model of Care
  • NEW: Flu Testing and Treatment
  • Policy Effective January 2, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash December 5, 2023

  • Effective 3/1/24: Prior Authorization Update
  • Effective 1/1/24: New Pharmacy Benefit Manager
  • PROHIBITED: Balance Billing
  • Utilization Review: What You Need to Know
  • Monitoring Needed for Members Taking Antipsychotics

Provider Newsflash November 21, 2023

  • BILLING: Avoid Claim Denials
  • UPDATED: Billing Matrix
  • Antibiotic Awareness Week
  • REQUIRED: Appointment and Office Site Standards
  • IMPORTANT: Provider Statement of Need
  • Effective November 20, 2023: Clinical Policies
  • Effective December 1, 2023: Pharmacy and Biopharmacy Policies
  • Effective January 31, 2024: Clinical Policies
  • Effective February 1, 2023: Pharmacy and Biopharmacy Policies
  • Effective February 29, 2024: Clinical Policies

Provider Newsflash November 7, 2023

  • Deadline Approaching for Medicare Annual Enrollment Period
  • EFFECTIVE 1/1/24: New Claim Review Process
  • Tools for Your Practice During COPD Awareness Month
  • Important Cultural Competency, Health Equity and NMDOH Resources
  • HHSC Launches Website Connecting Direct Care Employees with Employers
  • Effective January 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash October 24, 2023

  • NEW: DME, Prosthetics, Orthotics and Medical Supplies Online Platform
  • 11/1: Ambetter Health Open Enrollment
  • STAR Health Trauma-Informed Care Alternative Payment Model
  • Are You Missing These Critical Reporting Requirements?
  • APPLY NOW: Recruitment and Retention Support Programs
  • Effective November 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash October 10, 2023

  • EFFECTIVE 1/1/24: Transition of Utilization Review
  • MissionCare Partnership: Recruitment and Retention Webinars
  • Effective 10/1: Collaborative Care Model Rate Change
  • Training Requirement: Model of Care
  • Health Passport Requirements for Behavioral Health Providers

Provider Newsflash September 26, 2023

  • REQUIRED: Provider Enrollment Revalidation
  • Secure Portal: Manage Tasks Quickly and Easily
  • 2023-2024 Value-Added Services Update
  • Join the Fight Against the Flu
  • NEW: Health Passport Updates
  • Effective September 25, 2023: Clinical Policies
  • Effective October 31, 2023: Clinical Policies

Provider Newsflash September 12, 2023

  • Effective 10/1: Prior Authorization Changes
  • New: MissionCare Collective Partnership
  • 3 in 30 Assessments
  • ACTION REQUIRED: Rate Enhancement
  • 9/1: New Health Passport Form
  • Effective October 2, 2023: Pharmacy and Biopharmacy Policies
  • Effective December 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash August 29, 2023

  • URGENT: Incorrect Term of Member Coverage
  • DUE 10/1: EVV Provider Onboarding Deadline
  • STAR+PLUS Contract Award Updates
  • Submit Attestations Online for Chronically Ill Members
  • Improving Health through Quality Improvement
  • Effective September 1, 2023: Pharmacy and Biopharmacy Policies
  • Effective November 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash August 15, 2023

  • PROHIBITED: Balance Billing
  • Monitoring Needed for Members Taking Antipsychotics
  • Due 8/31: HHSC Survey
  • NEW: Podimetrics SmartMat™ Pilot
  • Coming Soon: Provider Satisfaction Survey

Provider Newsflash August 1, 2023

  • URGENT: COVID-19 Flexibilities Ending
  • Provider Satisfaction Survey
  • Effective 7/15: Authorization Update
  • JOIN US: Provider Advisory Groups
  • Health Passport Requirements for Behavioral Health Providers Serving STAR Health Members
  • Effective August 1, 2023: Pharmacy and Biopharmacy Policies
  • Effective October 2, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash July 18, 2023

  • QUICK! Customize News Preferences Now
  • Due 8/31: HHSC Survey
  • Temporary Add-Ons for Nursing Facilities
  • REFERRAL REQUIREMENTS: Ambetter Value and Virtual Access Plans
  • APPLY NOW: Provider Grant Up To $5,000

Provider Newsflash July 5, 2023

  • Effective 7/1: Removal of Prior Authorization for Certain Services
  • Addressing Non-Medical Drivers of Health
  • Training Requirement: Model of Care
  • Effective 7/27: Texas Medicaid Preferred Drug List Updates
  • Due 10/1: Actions for Transitioning to New EVV Vendor
  • Effective July 3, 2023: Pharmacy and Biopharmacy Policies
  • Effective September 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash June 20, 2023

  • NOW RESUMED: Co-Pays for Certain CHIP Services
  • Home and Community-Based Services Provider Retention Payments
  • Medicare Benefits Resumed for Applicable COVID-19 Services
  • REQUIRED: Is Your Information Accurate?
  • TRAINING: Suicide Prevention

Provider Newsflash June 6, 2023

  • Effective 7/1: Prior Authorization Changes
  • URGENT: Drug Shortages
  • Due 8/23: HHSC Survey
  • Provider Trainings Available
  • REQUIRED: 3 in 30 Assessment
  • Effective June 1, 2023: Pharmacy and Biopharmacy Policies
  • Effective August 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash May 23, 2023

  • SUPPORT FOR MEMBERS IN ALLEN AND BROWNSVILLE
  • Monitoring Needed for Members Taking Antipsychotics
  • Secure Portal: Manage Tasks Quickly and Easily
  • IMPORTANT: EVV Vendor Transition
  • PROHIBITED: Balance Billing
  • Effective May 22, 2023: Clinical Policies
  • Effective July 31, 2023: Clinical Policies

Provider Newsflash May 9, 2023

  • URGENT: COVID-19 Flexibilities Ending
  • Training Requirement: Model of Care
  • Asthma Awareness Month
  • Care Management Program Benefits
  • GUIDE AVAILABLE: Antidepressant Medication Management
  • Effective May 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash April 25, 2023

  • ACCESS: New Online Provider Toolkit
  • REQUIREMENTS: Appointment and Office Site Standards
  • Effective 4/7: Makena Products No Longer Covered
  • Provider Credentialing Information and Rights
  • Health Passport Requirements

Provider Newsflash April 11, 2023

  • PRIOR AUTH: Denial Updates
  • URGENT: Loss of Coverage
  • Do Your Patients Understand Their Rights and Responsibilities?
  • Potentially Harmful Drug-Disease Interactions
  • April 22: Drug Take Back Day
  • Clinical Payment Policy Revisions: Effective July 1, 2023

Provider Newsflash March 28, 2023

  • IMPORTANT: Co-pays Resuming for Certain Services
  • Inpatient Hospital Policy Extension for COVID-19 PHE Ending
  • State Fair Hearings Flexibility Ending
  • Behavioral Health Tools and Resources
  • Diabetes Alert Day and Diabetes Reversal Program
  • Effective March 27, 2023: Clinical Policies
  • Effective April 1, 2023: Pharmacy and Biopharmacy Policies
  • Effective May 31, 2023: Clinical Policies

Provider Newsflash March 14, 2023

  • NEW: Risk Adjustment Documentation and Coding Webinars
  • JOIN US: Provider Advisory Groups
  • Urgent: Loss of Coverage
  • Member Survey Regarding Provider Experience
  • Medicaid Applied Behavior Analysis Services for Children and Youth With Autism

Provider Newsflash February 28, 2023

  • Effective 3/1: Prior Auth Ending
  • Relaxation of Prior Authorization Requirements
  • IMPORTANT: Updated Procedure Codes
  • Monitoring Needed for Members Taking Antipsychotics
  • JOIN US: Behavioral Health Town Hall
  • Effective March 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash February 14, 2023

  • Urgent: Loss of Coverage
  • Provider News Customized to Your Location, Specialty and Superior Products
  • Important Claim Information
  • REQUIRED: Resident Transaction Notices
  • Cervical Cancer Reporting Guidelines

Provider Newsflash January 31, 2023

  • PROHIBITED: Balance Billing
  • REQUIRED: Is Your Information Accurate?
  • Training Requirement: Model of Care
  • Pharmacological Management of COPD
  • Important 2023 Medicare Coverage Changes
  • Effective January 23, 2023: Clinical Policies
  • Effective January 31, 2023: Clinical Policies
  • Effective March 31, 2023: Clinical Policies
  • Effective May 1, 2023: Clinical Policies

Provider Newsflash January 17, 2023

  • Effective 1/26: Preferred Drug List Updates
  • Health Passport Requirements
  • NOW AVAILABLE: Collaborative Care Model Training
  • NEW: Incentive Payments through Payspan
  • Secure Portal: Manage Tasks Quickly and Easily

Provider Newsflash December 13, 2022

  • MUST-HAVE: Provider Resources and Tools
  • Surveys to Improve Member and Provider Satisfaction
  • GUIDE AVAILABLE: Antidepressant Medication Management
  • Help Prevent Medication Problems and Adverse Drug Events
  • Ambetter Provider Training
  • Effective February 1, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash November 29, 2022

  • 90% Increase in Flu Immunization
  • Effective 1/1/23: Prior Authorization Changes
  • Training Requirement: Model of Care
  • PROHIBITED: Balance Billing
  • CAHPS Guide: Getting Needed Care
  • Effective November 30, 2022: Clinical Policies
  • Effective December 1, 2022: Pharmacy and Biopharmacy Policies
  • Effective January 31, 2023: Clinical Policies

Provider Newsflash November 15, 2022

  • BILLING: Avoid Claim Denials
  • CEs AVAILABLE: COPD Awareness Month
  • EFFECTIVE 1/1/23: Medicaid Hepatitis C Treatment Coverage Update
  • IMPORTANT: Utilization Review Process
  • UPDATE: Health Passport
  • Effective January 3, 2023: Pharmacy and Biopharmacy Policies

Provider Newsflash November 1, 2022

  • REQUIREMENTS: Appointment and Office Site Standards
  • DEADLINE: Medicare Open Enrollment
  • Antibiotic Awareness Week
  • Ambetter Health Open Enrollment
  • NEW: Flu Testing and Treatment
  • Effective November 1, 2022: Pharmacy and Biopharmacy Policies

Provider Newsflash October 18, 2022

  • BILLING CODES: Flu Vaccination
  • NOTICE: Outpatient Pharmacy Copayments for COVID-19
  • JOIN US: Behavioral Health Town Hall
  • October 29: Drug Take Back Day
  • HEALTH ALERT: Potential Surge In Infectious Disease

Provider Newsflash October 4, 2022

  • EXPANDED RECALL: Pediatric Formulas
  • UPDATE: Genetic and Molecular Testing Services
  • REQUIRED TRAINING: Self-Study Program
  • UPDATE: Value-added Services
  • Secure Portal: Manage Tasks Quickly and Easily
  • Effective September 26, 2022: Clinical Policies
  • Effective October 3, 2022: Pharmacy and Biopharmacy Polices
  • Effective November 30, 2022: Clinical Policies
  • Effective December 1, 2022: Pharmacy and Biopharmacy Policies

Provider Newsflash September 20, 2022

  • Effective 9/1: Prior Authorization Updates
  • IMPORTANT: Suicide Prevention Training Available
  • EFFECTIVE 12/1: Billing Matrix Updates
  • Pharmacy Guide: Auth Requirements, Formularies and Quantity Limits
  • Cultural Competency, SDOH and Social Vulnerability Resources

Provider Newsflash September 6, 2022

  • COVID-19 Vaccine Codes Are Now Benefits
  • ACTION REQUIRED: Rate Enhancement
  • HHSC Publishes Payment Rates for FMSA Providers
  • Updated Medicare Peer-to-Peer Review and Elective Inpatient PA Processes
  • Effective 10/1: Prior Authorization Changes
  • Effective September 1, 2022: Pharmacy and Biopharmacy Policies

Provider Newsflash August 23, 2022

  • Updated Effective Date: Genetic and Molecular Testing
  • NEW: Preferred Meter and Test Strips
  • Kate Farms Voluntary Recall of Formula
  • Potentially Harmful Drug-Disease Interactions 
  • GUIDANCE NEEDED: Improving Health through Quality Improvement

Provider Newsflash August 9, 2022

  • Effective 9/1: Update to Children and Pregnant Women Services
  • PROHIBITED: Balance Billing 
  • Reporting Requirement 
  • Provider Satisfaction Survey
  • Training Requirement: Model of Care
  • Effective August 1, 2022: Pharmacy and Biopharmacy Policies
  • Effective October 3, 2022 Pharmacy and Biopharmacy Policies

Provider Newsflash July 26, 2022

  • Effective 8/1: Removal of Prior Auth Requirement
  • Therapy Services: Early Childhood Intervention Services
  • PROVIDER REQUIREMENT: Health Passport
  • GUIDE AVAILABLE: Reducing Side Effects from Antidepressants
  • URGENT: COVID-19 Vaccinators Needed
  • Effective July 25, 2022: Clinical Policies
  • Effective September 30, 2022: Clinical Policies

Provider Newsflash July 12, 2022

  • Effective 7/6: New Fax Number for Prior Authorization Requests
  • Helpful Resources During the U.S. Formula Shortage
  • 2022 Practice Guidelines: Your Feedback is Needed
  • Medical Records Retrieval Project
  • Trauma Resource Guide Available
  • Acute Care Hospitalizations Payment Policy - Sepsis Diagnosis

June 28, 2022 Provider Newsflash

  • Effective 7/15: Temporary Relaxation of Prior Authorization Requirements for Formula  
  • Now Available: COVID-19 Vaccines for Children 6 Months - 5 Years of Age
  • Home and Community-Based Services (HCBS) Provider Retention Payments
  • DEADLINE EXTENSION: Value-Based Provider Program
  • CEs AVAILABLE: Person Centered Thinking Training
  • Effective July 1, 2022: Pharmacy and Biopharmacy Policies

June 14, 2022 Provider Newsflash

  • Effective 7/1: Prior Authorization Requirements
  • Genetic and Molecular Testing through NIA
  • Effective 6/1: EVV Policy Revisions
  • DEADLINE EXTENSION: Value-Based Provider Program
  • Effective 7/1: Certain Co-payments Waived
  • Effective June 1, 2022: Pharmacy and Biopharmacy Policies

May 31, 2022 Provider Newsflash

  • SUPPORT FOR SUPERIOR MEMBERS IN UVALDE
  • Help Prevent Medication Problems and Adverse Drug Events
  • Addressing Social Determinants of Health
  • Important: Prior Authorization Submission Requirement
  • GUIDE AVAILABLE: How to Increase Medication Adherence
  • Effective May 18, 2022: Clinical Policies
  • Effective August 15, 2022: New Payment Policy - E/M Services Billed with Treatment Room Revenue Codes

May 17, 2022 Provider Newsflash

  • BILLING REQUIREMENT: Billing Modifier and Code
  • HHS Telemedicine and Telehealth Survey
  • PROHIBITED: Balance Billing
  • DUE 7/1: Incentive Program Survey
  • How Superior is Removing Barriers to Care

May 3, 2022 Provider Newsflash

  • Permanent Relaxation of Prior Authorization Requirements
  • Asthma Awareness Month
  • Postponed: Pharmacy Prior Authorization Fax Number Update
  • Care Management Program Benefits
  • APPLY NOW: Provider Grant Up To $5000
  • Effective May 2, 2022: Pharmacy and Biopharmacy Policies

April 19, 2022 Provider Newsflash

  • 5/16 DEADLINE: DAHS Value-Based Program
  • EFFECTIVE 5/15: Notice of Adverse Benefit Determination Fax Update
  • DON’T MISS: Drug Take Back Day
  • Provider Credentialing Information & Rights
  • Training Requirement: Model of Care

April 5, 2022 Provider Newsflash

  • Effective May 1, 2022: Removal of Prior Auth Requirement
  • EVV Required Free Text Reviews Postponed
  • Effective May 1, 2022: Genetic Testing Procedure Codes
  • PARTICIPATION NEEDED: Community Health Centers
  • Do Your Patients Understand Their Rights and Responsibilities?
  • Effective March 28, 2022: Clinical Policies
  • Effective May 31, 2022: Clinical Policies
  • Effective June 1, 2022: Pharmacy and Biopharmacy Policies

March 22, 2022 Provider Newsflash

  • NEW: Access Illness Insights and Alerts
  • NEW: Provider Trainings Available 
  • Effective 6/1: Changes to Mosquito Repellent Benefit
  • Updated: Behavioral Health Tools and Resources
  • New Webinar Series: Emergency Preparedness
  • Effective April 1, 2022: Pharmacy and Biopharmacy Policies
  • Effective May 1, 2022: Pharmacy and Biopharmacy Policies

March 8, 2022 Provider Newsflash

  • Effective 7/1: Billing Code Updates
  • REQUIREMENTS: Quarterly Review Process
  • GUIDE AVAILABLE: Reducing Side Effects from Antidepressants 
  • Member Survey Regarding Provider Experience
  • Help Prevent Medication Problems and Adverse Drug Events
  • Effective April 1, 2022: New Payment Policy - Enhanced Code Editing
  • Effective June 1, 2022: Clinical Payment Policy Revision - Attention Deficit Hyperactivity Disorder (ADHD) Assessment and Treatment

February 22, 2022 Provider Newsflash

  • News Customized To Your Region, Specialty and Superior Products
  • UPDATE: Temporary Relaxation of Prior Authorization Requirements 
  • BILLING REQUIREMENTS: Virtual and Value Plans   
  • REMINDER: Rate Increase
  • Monitoring Needed for Members Taking Antipsychotics

February 8, 2022 Provider Newsflash

  • Effective 2/1: Prior Auth Ended
  • Effective 5/1: Prior Auth Requirement
  • CEs AVAILABLE: New Human Trafficking Training 
  • Cervical Cancer Reporting Guidelines
  • HHS Needs Your Feedback by 2/18
  • Effective February 1, 2022: Pharmacy and Biopharmacy Policies
  • Effective May 1, 2022: Clinical Policies

January 25, 2022 Provider Newsflash

  • AVOID DENIALS: STAR Health HHS Bill Code Table Updates
  • PROHIBITED: Balance Billing 
  • Not a Covered Benefit: Interfyl 
  • REQUIRED: Is Your Information Accurate?
  • Training Requirement: Model of Care 
  • Effective April 15, 2022: Clinical Payment Policy Revision - Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing
  • Effective April 15, 2022: Clinical Payment Policy Revision - Testing for Select Genitourinary Conditions

January 11, 2022 Provider Newsflash

  • EFFECTIVE 1/3: HHS EVV Policy Revisions
  • 1/31 Reimbursement Extensions Due to COVID
  • Prior Auth Requests for Physical, Occupational and Speech Therapy Services
  • Secure Provider Portal: Manage Tasks Quickly and Easily
  • PROVIDER GRANT AVAILABLE: Removing Barriers to Accessibility
  • Effective January 3, 2022: Pharmacy and Biopharmacy Policies
  • Effective February 15, 2022: Payment Policy – 340B Drug Payment Reduction

December 14, 2021 Provider Newsflash

  • HHS Flexibility Ending Due to COVID-19
  • AVAILABLE TO YOU: Unvaccinated Patient List
  • HHS UPDATE: Flu Vaccine Guidance
  • 12/16 Webinar: Preventing Suicide Among Providers and Staff
  • EVALUATION MAY BE NEEDED: Prevent Adverse Drug Events
  • Effective February 1, 2022: Pharmacy and Biopharmacy Policies

December 2, 2021 Medicare News

  • Medicare Billing Requirements
  • 12/7 DEADLINE: Medicare Open Enrollment
  • Improving Member and Provider Services
  • MUST-HAVE: Medicare Provider Resources and Tools 

November 30, 2021 Provider Newsflash

  • REQUIREMENT: Model of Care Training
  • DEADLINE: Ambetter Open Enrollment
  • Child Psychiatry Resources and Trainings
  • Effective November 22, 2021: Clinical Policies
  • Effective December 1, 2021: Pharmacy and Biopharmacy Policies

November 16, 2021 Provider Newsflash

  • COVID-19 VACCINE: Approved for Children 5-11 Years Old 
  • Effective 2/1: Prior Auth Required for New Benefit
  • BILLING: Prohibited Practice
  • STAR Health Trauma-Informed Care Alternative Payment Model
  • Improving Member and Provider Services
  • Effective December 1, 2021: Clinical Policies
  • Effective January 3, 2022: Pharmacy and Biopharmacy Policies
  • Effective February 1, 2022: Clinical Payment Policy Revision - Allergy Testing and Immunotherapy

November 11, 2021 Ambetter News

  • AMBETTER BILLING: Prohibited Practice
  • DEADLINE: Ambetter Open Enrollment
  • Improving Member and Provider Services
  • MUST-HAVE: Ambetter Provider Resources and Tools 

November 2, 2021 Provider Newsflash

  • NEW: Medicaid Enrollment Requirement
  • Medicaid and CHIP Eligibility Requirement
  • REQUIREMENTS: Appointment and Office Site Standards
  • 11/5: HHS Rate Methodology Evaluation Webinars
  • NEW: Care Management Program for Patients
  • Effective November 1, 2021: Pharmacy and Biopharmacy Policies

October 19, 2021 Provider Newsflash

  • NEW: Ambetter Value and Virtual Plan
  • NEW: Preferred Pen Needles
  • Antibiotic Awareness Week
  • Improvement Initiatives for Model of Care
  • DEADLINE: Medicare Open Enrollment
  • Effective October 18, 2021: Pharmacy and Biopharmacy Policies
  • Effective October 18, 2021: Pharmacy and Biopharmacy Policies

October 5, 2021 Provider Newsflash

  • UPDATED CODE LIST: Temporary Relaxation of Prior Auth Requirements
  • NEW: Wellcare By Allwell
  • The Use of Ivermectin and COVID-19
  • Utilization Review Process: What You Need to Know
  • October 23: Drug Take Back Day
  • Effective October 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective October 6, 2021: Clinical Policies
  • Effective November 1, 2021: Clinical Policies
  • Effective December 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective December 2, 2021: Clinical Policies
  • Effective January 1, 2022: Medicare Payment Policy

September 28, 2021 Provider Newsflash

  • NEW: 2021-2022 Flu Testing and Treatment
  • NOTICE: EVV Compliance for State-Required Personal Care Services Providers
  • NEW: Electronic Disaster Relief System 
  • Cultural Competency Resources and Language Services Available
  • Secure Provider Portal: Manage Tasks Quickly and Easily

September 16, 2021 Medicaid Provider News

  • New Prior Authorization Requirements: Synagis for RSV
  • AVOID DENIALS: Medicaid Claims Tips
  • New CAHPS Guide: Getting Needed Care
  • MUST-HAVE: Medicaid Provider Resources and Tools 

September 7, 2021 Provider Newsflash

  • Billing Codes and Recommendations for Flu Vaccination
  • ACTION REQUIRED: Rate Enhancement
  • 9/30 Webinar: Help Reverse Type 2 Diabetes
  • 2021-2022 Value-added Services Update
  • Monitoring Needed for Members Taking Antipsychotics

August 24, 2021 Provider Newsflash

  • EXTENDED: Temporary Relaxation of Prior Authorization Requirements
  • DFPS Implementation of Mobile App
  • EVV Recoupment of Overpayments Process
  • GUIDANCE NEEDED: Improving Health through Quality Improvement
  • EVALUATION MAY BE NEEDED: Prevent Adverse Drug Events

August 10, 2021 Provider Newsflash

  • Effective 9/1: Prior Authorization Change
  • Same-Day CANS 2.0 Assessments and Psychological/Neuropsychological Testing 
  • REMINDER: Balance Billing Prohibited
  • 2021 Provider Satisfaction Survey
  • Help Members Manage Antidepressant Medications
  • Effective August 2, 2021: Clinical Policies
  • Effective August 2, 2021: Pharmacy and Biopharmacy Policies
  • Effective August 9, 2021: Pharmacy and Biopharmacy Policies
  • Effective October 1, 2021: Clinical Policies
  • Effective October 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective October 4, 2021: Pharmacy and Biopharmacy Policies

July 27, 2021 Provider Newsflash

  • Effective 7/29: Texas Medicaid Preferred Drug List Updates
  • Temporary Relaxation of Prior Authorization Requirements
  • Removal of Prior Authorization Requirement for Spinal Muscular Atrophy
  • Removal of Policy Updates
  • HHS Reopened RSV Season in Selected Regions

July 13, 2021 Provider Newsflash

  • News Customized To Your Region, Specialty and Superior Products
  • Effective July 25, 2021: Removal of Prior Authorization Requirement
  • Update Email to Receive Texas CANS 2.0 Alerts
  • Due August 31, 2021: Your Feedback is Requested
  • Annual Training Requirement

June 29, 2021 Provider Newsflash

  • COVID-19: Increased Vaccine Access for Texans
  • NOW AVAILABLE: Medical Ride Program
  • REQUIREMENT: Become a CANS 2.0 Certified Provider
  • Interoperability: Digitally Connecting Members, Providers and Payers
  • Medicare: Expanded Formulary Information
  • Effective June 30, 2021: Pharmacy and Biopharmacy Policies
  • Effective July 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective September 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective September 23, 2021: Pharmacy and Biopharmacy Policies

June 15, 2021 Provider Newsflash

  • AVOID DENIALS: Updated Billing Guidelines
  • Help Patients Reverse Type 2 Diabetes with Virta
  • Assist Members with Cancer
  • Reporting Abuse, Neglect and Exploitation
  • Rejected Claims and Timely Claim Filing
  • Effective August 2, 2021: Pharmacy and Biopharmacy Policies

June 1, 2021 Provider Newsflash

  • Effective August 1, 2021: Prior Authorization Requirements
  • Provider Payment Model for Trauma-Informed Care
  • BILLING UPDATES: Mental Health Targeted Case Management and Rehabilitation
  • REFER MEMBERS: Disease Management Program
  • EVALUATE NOW: Potentially Harmful Drug-Disease Interactions
  • Effective June 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective June 7, 2021: Clinical Policies
  • Effective July 31, 2021: Clinical Policies

May 18, 2021 Provider Newsflash

  • Effective June 1, 2021: Removal of Prior Authorization Requirement for PT/OT/ST
  • COVID-19 Support for Surging Hospitals and Facilities
  • Addressing Social Determinants of Health
  • Additional Screening and Monitoring Needed
  • PROVIDER TIPS: Improve Medication Management
  • Effective May 12, 2021: Pharmacy and Biopharmacy Policies
  • Effective July 1, 2021: Pharmacy and Biopharmacy Policies

May 4, 2021 Provider Newsflash

  • Billing Requirements and Payment Policy: Members Who Are Transgender
  • PROHIBITED: Balance Billing
  • Updates to Required Documentation for Quarterly Retrospective Review
  • Care Management: Helping Providers Assist Members
  • COVID-19: Nursing Facility Strategies and Resources
  • UPDATE: Removal of Authorization Requirements
  • AUTHORIZATION REQUIREMENTS: Documentation for Medical Necessity
  • DON’T MISS: Drug Take Back Day
  • A Guide to Understanding Practitioner Credentialing Rights
  • How Can I Improve HEDIS Scores?
  • COVID-19: Vaccine Billing and Testing Guidelines
  • NOW AVAILABLE: Person Centered Thinking TrainingTraining Requirement: Model of Care
  • Training Requirement: Model of Care
  • Do Your Members Understand Their Rights and Responsibilities?
  • Helping Texas Communities Thrive
  • Effective April 5, 2021: Clinical Policies
  • Effective April 5, 2021: Pharmacy and Biopharmacy Policies
  • Effective April 9, 2021: Pharmacy and Biopharmacy Policies
  • Effective May 31, 2021: Clinical Policies
  • Effective June 15, 2021: Clinical Payment Policy - Drugs of Abuse: Presumptive Testing
  • Effective June 15, 2021: Payment Policy - Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds
  • Effective June 15, 2021: Renal Hemodialysis
  • Effective July, 2021: Clinical Policies

March 23, 2021 Provider Newsflash

  • New SUD Program to Support Members
  • Effective 5/17: Prior Authorization Updates for Therapy Services
  • Monitoring Needed for Members Taking Antipsychotics
  • Potentially Harmful Drug-Disease Interactions
  • Access Behavioral Health Tools

March 9, 2021 Provider Newsflash

  • Updated PA Requirements for Cardiac Surgeries
  • New ENT Surgery and Sleep Study Program
  • NEW: 2021 Superior Hospital POD
  • Member Survey Results on Their Provider Experience
  • GUIDE AVAILABLE: Reducing Side Effects from Antidepressants 
  • Effective March 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective March 12, 2021: Pharmacy and Biopharmacy Policies
  • Effective May 3, 2021: Pharmacy and Biopharmacy Policies

February 23, 2021 Provider Newsflash

  • NEW: Prior Auth Forms and Fax Lines
  • Effective 1/1: Formulary and Prescription Alternatives Updates
  • BILLING: Prohibited Practice
  • Claim Billing Guidelines for PA Requirements
  • CMEs Available for Upcoming Child Psychiatry Access Network Webinars

February 9, 2021 Provider Newsflash

  • REIMBURSEMENT UPDATES: Telemedicine and Telehealth
  • Provider Incentive Program
  • NEW: Durable Medical Equipment Provider Partnership
  • Cervical Cancer Reporting and Prevention
  • VIDEO: STAR Health Success
  • Effective February 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective April 1, 2021: Clinical Policies
  • Effective April 1, 2021: Pharmacy and Biopharmacy Policies

January 27, 2021 Provider Newsflash

  • NEW REQUIREMENT: Controlled Substances
  • Annual Training Requirement
  • REQUIRED: Demographic Updates
  • Helpful Tips for Risk Adjustment
  • DON’T MISS: Valuable Provider Resources

January 12, 2021 Provider Newsflash

  • Requirements to Administer COVID-19 Vaccine
  • COVID-19 Vaccine Information and Resources
  • PA Requirement for Biologic DMARDs
  • HHS Enhanced Postpartum Care Services
  • EASY ACCESS: Valuable Provider Resources
  • Effective December 1, 2020: Pharmacy and Biopharmacy Policies
  • Effective January 15, 2021: Pharmacy and Biopharmacy Policies
  • Effective Feburary 1, 2021: Pharmacy and Biopharmacy Policies
  • Effective February 15, 2021: Clinical Policies
  • Effective March 1, 2021: Pharmacy and Biopharmacy Policies
     

December 8, 2020 Provider Newsflash

  • Prior Auth Requirement: Home Telemonitoring
  • NEW: Provider Accessibility Initiative
  • Effective 1/1: Therapy Prior Auth Requirements
  • Help Reduce Side Effects from Antidepressants
  • Authorization, Risks and Use: Proton Pump Inhibitors
  • Effective December 1, 2020: Pharmacy and Biopharmacy Policies
  • Effective February 1, 2021: Pharmacy and Biopharmacy Policies

November 4, 2020 Provider Newsflash

  • NEW: COVID-19 Procedure Codes
  • INCENTIVES AVAILABLE: Join Project ECHO
  • UPDATES: Prior Authorization Requirements
  • DMARD Therapy Tip Sheets Available 
  • Effective 1/1: New Authorization Requirements
  • Effective January 18, 2021: Pharmacy and Biopharmacy Policies

November 10, 2020 Provider Newsflash

  • Medication Prior Authorization Requirements, Processing and Limits
  • When It Comes to the Flu, You Call the Shots
  • Potentially Harmful Drug-Disease Interactions
  • BILLING: Prohibited Practice
  • Antibiotic Awareness Week
  • Effective November 10, 2020: Pharmacy and Biopharmacy Policies
  • Effective November 30, 2020: Clinical Policies

October 27, 2020 Provider Newsflash

  • REQUIRED: Appointment and Office Site Standards
  • Updated Billing Requirements
  • Open Enrollment Begins November 1
  • REMINDER: Required Model of Care Training
  • CE Credits Available: Reducing Stigma Associated with Opioid Use Disorder
  • Effective January 15, 2021: Payment Policy - Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular Procedures

October 13, 2020 Provider Newsflash

  • NEW HHS REQUIREMENT: Personal Care Services Oversight
  • DEADLINE: Open Enrollment 
  • IMPROVEMENT INITIATIVES: Model of Care
  • Monitoring Needed for Members Taking Antipsychotics
  • DON’T MISS: Drug Take Back Day
  • Effective October 30, 2020: Clinical Policies
  • Effective October 6, 2020: Pharmacy and Biopharmacy Policies
  • Effective January 1, 2021: Pharmacy and Biopharmacy Policies
  • Clinical Payment Policy: Polymerase Chain Reaction Respiratory Viral Panel Testing - Effective January 15, 2021

September 29, 2020 Provider Newsflash

  • NEW: 2020-2021 Flu Testing and Treatment
  • NOTICE: Admission Record Requirement
  • Opioid Toolkit: Naloxone Resources
  • Utilization Review Process: What You Need to Know
  • COMPLETE SURVEY BY 10/16
  • Effective November 17, 2020: Pharmacy and Biopharmacy Policies

September 15, 2020 Provider Newsflash

  • Flu Billing Codes and Recommendations
  • Cultural Competency Resources and Language Services Available
  • NOW AVAILABLE: Continuing Education Resources for Adults and Children
  • RECALL: Metformin Tablets
  • Reduce High Anticholinergic Burden (ACB) Scores
  • Effective September 16, 2020: Pharmacy and Biopharmacy Policies

September 1, 2020 Provider Newsflash

  • ACTION REQUIRED: Rate Enhancement
  • Requirements for STAR+PLUS and MMP Services
  • Requirements for STAR Kids and STAR Health Services
  • Improving Health through Quality Improvement
  • Pharmacy Guide: Auth Requirements, Formularies and Quantity Limits
  • Effective October 1, 2020: Clinical Policies

August 18, 2020 Provider Newsflash

  • PROHIBITED: Balance Billing 
  • DUE 8/28: Application for Provider Relief Fund
  • Provider Satisfaction Survey Feedback Creates Change 
  • EFFECTIVE 9/1: New Opioid Policy
  • IMMUNIZATIONS: Important Information and Resources
  • Attention Deficit Hyperactivity Disorder Assessment and Treatment Policy Update - Effective 11/1/20
  • Allergy Testing and Therapy Policy Update - Effective 11/01/20

August 4, 2020 Provider Newsflash

  • HHS Requirement: Private Duty Nursing Prior Authorization Form
  • Policies Effective September 
  • Increase for COVID-19 Treatment Services 
  • ALERT: High-Risk Medications
  • PROVIDER INCENTIVES: Medication Management

July 21, 2020 Provider Newsflash

  • Effective 10/1: New Ambetter Auth Requirements
  • Potentially Harmful Drug-Disease Interactions
  • New Features: Texas Health Passport
  • REQUIREMENT: Model of Care Training
  • Are You Missing Important Updates?

July 7, 2020 Provider Newflash

  • CLAIM REQUIREMENTS
  • Requirement for Ventilators
  • Prior Authorization Approval Notice
  • 2021 Practice Guidelines: Your Feedback is Needed
  • July 2020: New Drugs Requiring Utilization Management

June 23, 2020 Provider Newsflash

  • New TDI Rule: Billing Protections
  • Senate Bill 1264: What Providers Need to Know
  • Continuing Education Trainings Available
  • TEXAS LAW: Abuse, Neglect and Exploitation Reporting
  • Surveys to Improve Member and Provider Satisfaction

June 9, 2020 Provider Newsflash

  • Rejected Claims and Timely Claim Filing
  • PREPARE NOW: EVV Practice Period 
  • HHS Housing Choice 
  • Disease Management for Your Patients
  • Medication Management for Antidepressants
  • COVID-19: Actions for Providers
  • PROHIBITED: Balance Billing
  • Submit Correct Prior Authorization Forms
  • NEW CHECKLIST: Prior Auth Requests
  • PROVIDER INCENTIVES: Medication Management 

May 12, 2020 Provider Newsflash

  • May 2020: New Drugs Requiring Utilization Management
  • NEW: EVV Portal Improvements
  • Extended Suspension of Face-to-Face Activities
  • ACCESS RESOURCES: Social Determinants of Health
  • COVID-19 Webinar: Provider Accessibility 

April 28, 2020 Provider Newsflash

  • COVID-19, BILLING & CLAIMS INFORMATION: Customized to You
  • COVID-19 Support for Grant Writing and Small Business Loan Applications
  • 7/1 DATE EXTENSION: Retrospective Utilization Review of Behavioral Health Inpatient Admissions
  • NOTICE: Behavioral Health and Place of Service Code Requirements for Claims
  • Care Management: Helping Providers Assist Members 

April 14, 2020 Provider Newsflash

  • COVID-19: Prior Auth and Benefit Updates
  • REMOVAL: Prior Authorization for Certain Services 
  • Potentially Harmful Drug-Disease Interactions
  • A Guide to Understanding Credentialing
  • Are You Meeting Immunization Requirements? 

March 31, 2020 Provider Newsflash

  • COVID-19: Latest Billing Information and Resources
  • EFFECTIVE 4/15: Wheelchair Prior Auth Update
  • Help Members Understand their Rights and Responsibilities
  • NEW: Immunization Toolkit
  • REQUIREMENT: Model of Care

March 17, 2020 Provider Newsflash

  • COVID-19: Actions and Guidance for Providers  
  • ENROLL NOW: Opioid Treatment Program
  • GET ACCESS NOW: Telemedicine Visit Summaries
  • Behavioral Health Enhancements and Tools
  • ENSURE COMPLIANCE: Medication Management

March 3, 2020 Provider Newsflash

  • Latest Facts about Coronavirus
  • NEW: Prior Authorization Forms and Fax Line Changes
  • PROHIBITED: Balance Billing
  • HHS Trainings: Evidence Based Practices
  • Patient Survey on Their Provider Experience

February 18, 2020 Provider Newsflash

  • New Prior Authorization Timeframe for CPAP and BiPAP
  • Provider Incentive Program
  • Telehealth Survey
  • EFFECTIVE 4/1: New Pharmacy Program
  • Join the Ambetter and Allwell Networks!

February 4, 2020 Provider Newsflash

  • Trauma-Informed Care Alternative Payment Model Launching 2/1
  • Revised Clinical Policy for Therapy Services
  • Effective 5/1: Retrospective Utilization Review
  • Reporting and Prevention Guidelines for Cervical Cancer
  • Superior HealthPlan and WellCare

January 21, 2020 Provider Newsflash

  • HHS Guidelines: Pharmacy Psychotropic Medication
  • REQUIRED: Is Your Information Accurate?
  • EFFECTIVE 1/30: Medicaid PDL Updates
  • Provider Trainings Available
  • VIDEO: Submitting an Institutional Claim

January 7, 2020 Provider Newsflash

  • Want Superior News Customized to Your Practice?
  • Potentially Harmful Drug-Disease Interactions in Older Adults (DDE)
  • Now Available: Care Gap Information 
  • EVV Visit Maintenance: Extension Reminder
  • Ophthalmology Provider Transition 
     

December 10, 2019 Provider Newsflash

  • CLAIM REQUIREMENT: Payer ID
  • Pharmacy Processing Quick Reference Guides
  • AMBETTER PROVIDERS: PPI Treatment Options
  • AVOID DIRECTORY REMOVAL: VERIFY YOUR INFORMATION 
  • PROVIDER RECOGNIZED FOR EXEMPLARY PERFORMANCE

November 26, 2019 Provider Newsflash

  • New: Prior Authorization Forms and Fax Line Changes
  • New: Prior Authorization Forms and Fax Line Changes
  • REQUIREMENTS: Appointment and Office Site Standards 
  • CONTINUING EDUCATION: ONLINE PROVIDER TRAININGS 
  • UPDATE: AMBETTER FEE SCHEDULE 

November 12, 2019 Provider Newsflash

  • ATTENTION: Allwell (Medicare) and MMP Prior Authorization Updates
  • Provider Incentive Program 
  • Screening Requirement for Members with Diabetes
  • DEADLINE APPROACHING: OPEN ENROLLMENT 
  • COMING SOON: ANTIBIOTIC AWARENESS WEEK 

October 29, 2019 Provider Newsflash

  • PROHIBITED: Balance Billing
  • REQUIREMENT: Model of Care Training 
  • Improvement Initiatives for Model of Care
  • HHSC HEALTH ADVISORY: CONGENITAL SYPHILIS 
  • SUPERIOR HEALTHPLAN: 20 YEAR CELEBRATION 

October 15, 2019 Provider Newsflash

  • Effective 1/1/20: New Payment Policy
  • Removal of Prior Authorization Requirements 
  • NEW: Prior Authorization Guidelines for Synagis 
  • DEADLINE: MEDICARE OPEN ENROLLMENT 
  • 10/26: DRUG TAKE-BACK DAY 

October 1, 2019 Provider Newsflash

  • Mandatory Flu Vaccine Billing Codes
  • BILLING REQUIREMENTS: Patient Driven Payment Model
  • Utilization Review Process: What You Need to Know
  • CDC GUIDELINES: FLU TESTING AND TREATMENT 
  • HHSC REQUEST: DELAY EVV START DATE 

September 17, 2019 Provider Newsflash

  • PAYMENT POLICY IMPLEMENTATION: Physician Office Laboratory Testing
  • 9/1: LTSS Enrollment Deadline
  • Cultural and Social Resources to Enhance Member Care
  • AVOID DIRECTORY REMOVAL: VERIFY YOUR INFO 
  • HEALTH ALERT: SEVERE LUNG DISEASE 

September 3, 2019 Provider Newsflash

  • EFFECTIVE 9/1: LTSS Billing Matrix Changes
  • ACTION REQUIRED: Rate Enhancement Program
  • NEW: STAR+PLUS LTSS Rate Guide
  • MEDICARE PROVIDERS: PPI TREATMENT OPTIONS 
  • OVERVIEW: SUPERIOR PROGRAMS AND SERVICES

August 20, 2019 Provider Newsflash

  • DON'T MISS: ONLINE TRAINING TO TREAT OUD
  • August CAAC Meetings: Your Expertise is Requested
  • Join the QIC!
  • DME RENTAL TO PURCHASE CONVERSION
  • REMINDER: CLAIMS REIMBURSEMENT

August 6, 2019 Provider Newsflash

  • Effective 9/1: CentAccount Becomes My Health Pays
  • Ways to Avoid Claim Denials
  • Your Feedback is Important!
  • PROVIDER INCENTIVE PROGRAM! 
  • ATTENTION PROVIDERS: SUPPORT FOR MEMBERS IN EL PASO

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