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

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Provider Newsflash May 6, 2025

Is Your Provider Demographic Information Accurate?
10 Community Agencies Receive $10,000 Grants
Effective 7/1: Prior Authorization Changes
Do Your Patients Understand Their Rights and Responsibilities?
Effective August 1: Genetic Testing PLA Expansion
Effective May 1, 2025: Pharmacy and Biopharmacy PoliciesEffective
July 1, 2025: Pharmacy and Biopharmacy PoliciesEffective
July 1, 2025: Revised Payment Policy: Genetic and Molecular Testing Services
Effective August 1, 2025: Clinical Policies

Provider Newsflash April 22, 2025

Effective April 21: New Availity Claim Features and Webinars
Important: Post-Service Medical Necessity Appeal Submissions
Coming Soon: Provider Satisfaction Survey
Health Passport Requirements for Behavioral Health Providers
Coming Soon: PEMS Credentialing Updates
Effective July 1, 2025: New Payment Policy: Inpatient Claim Billing/Coding Reviews

Provider Newsflash April 8, 2025

Important Resources for Providers
New: tango-WellSky and Centene Partnership
April 26: Drug Take-Back Day
Access Behavioral Health Tools and Resources
July 1, 2025: Transition of Cardiology Utilization Review to Evolent
Effective March 31, 2025: Clinical Policies
Effective May 30, 2025: Clinical Policies

Provider Newsflash March 25, 2025

Effective 4/1: Removal of Prior Authorization
Elevating Patient Care Through Seamless Care Coordination
Account Management Department Name Update
Members Rate Their Provider Experience
COVID-19 Test Kits and Vaccine Updates
Effective April 1, 2025: Pharmacy and Biopharmacy Policies
Effective June 1, 2025: Pharmacy and Biopharmacy Policies

Provider Newsflash March 11, 2025

Important: Post-Service Medical Necessity Appeal Submissions
Training Requirement: Model of Care
Required: 3 in 30 for Your Patients
Appointment and Office Site Standard Requirements
Important Resource for Hospital Providers

Provider Newsflash February 25, 2025

Effective 4/1: Opioid Policy Changes
Important: Measles Outbreak
Coordinating Physical and Behavioral Health
Elevating Patient Care Through Courtesy
Get Customized News for Your Practice
Effective March 1, 2025: Pharmacy and Biopharmacy Policies
Effective May 1, 2025: Pharmacy and Biopharmacy Policies

Provider Newsflash February 14, 2025

Behavioral Health Prior Authorization for Additional Inpatient Days
IMPORTANT: Post-Service Medical Necessity Appeal Submissions
Notice of Changes by Medicare That May Affect Drug Coverage
ESRD Eligibility and Evidence Report
Provider Trainings Available

Provider Newsflash January 28, 2025

UPDATE: Sleep Study Authorizations
Billing: Behavioral Health Assessments
Refresher Training Webinar for CDS Employers
REQUIRED: Is Your Information Accurate?
Medicare Prescription Payment Program
Effective January 27, 2025: Clinical Policies
Effective March 31, 2025: Clinical Policies
Effective April 20, 2025: Clinical Policies
Effective April 20, 2025: Concert Genetic Testing Policies
Effective April 30, 2025: Clinical Policies

Provider Newsflash January 14, 2025

Apply for $10,000 Provider Grant
IMPORTANT: Post-Service Medical Necessity Appeal Submissions
Health Passport Requirements for Behavioral Health Providers
PROHIBITED: Balance Billing
EFFECTIVE 1/30: Medicaid PDL Updates
Effective January 1, 2025: Pharmacy and Biopharmacy Policies
Effective March 1, 2025: Pharmacy and Biopharmacy Policies
Effective March 31, 2025: New and Revised Clinical Payment Policies
Effective April 1, 2025: Sleep Studies Clinical Policies
Payment Policy Posting and Updates

Provider Newsflash December 17, 2024

Important Changes: New CANS 3.0 Assessment
Effective 12/1/24: Billing Reimbursement Changes
Training Requirement: Model of Care
Pharmacy Guide: PA Requirements, Formularies and Quantity Limits
Get Customized News for Your Practice

Provider Newsflash December 3, 2024

Effective 9/1:Transfer of Authorizations
Changes for Use of EVV Alternative Devices
Join the Fight Against the Flu
Effective 12/27/24: OnTrak Partnership Ends
ACCESS: Online Provider Toolkits
Effective November 25, 2024: Clinical Policies
Effective December 1, 2024: Pharmacy and Biopharmacy Policies
Effective January 31, 2025: Clinical Policies

Provider Newsflash November 19, 2024

IMPORTANT: Availity Live Training
COPD Awareness Month: Tips, Tools & Resources
EFFECTIVE 1/1/25: Substance Use Disorder Treatment Criteria
Utilization Review: What You Need to Know
JOIN US: Provider Advisory Groups

Provider Newsflash November 6, 2024

PROHIBITED: Balance Billing
11/1: Ambetter Health Open Enrollment
Join Us: Ambetter Health Day with Pro Football Hall of Famer
Health Passport Requirements for Behavioral Health Providers
NEW: DME Service Coordination Request Process
Effective February 1, 2025: Clinical Policies

Provider Newsflash October 22, 2024

Join Us: Ambetter Health Day with Pro Football Hall of Famer
NEW: DME Utilization Management Request Process Guide
ESRD Eligibility and Evidence Report
2024 Patient Ratings on Provider Care
Effective 9/1:Transfer of Authorizations
STAR Kids Clinical and Administrative Advisory Committee
Effective November 1, 2024: Pharmacy and Biopharmacy Policies
Effective January 1, 2025: Pharmacy and Biopharmacy Policies

Provider Newsflash October 8, 2024

Deadline for Medicare Annual Enrollment Period
Effective 10/1: COVID-19 Vaccine Coverage Updates
IMPORTANT: Bexar MMP Providers
Secure Portal: Manage Tasks Quickly and Easily
RSVP Today: Trauma-Focused Cognitive Behavioral Therapy Training
Effective September 23, 2024: Clinical Policies

Provider Newsflash September 24, 2024

Updated: Medicare Provider Services Number
IMPORTANT: Co-pays Resuming for Certain Services
HHSC REMINDER: Postpartum Medicaid and CHIP Coverage Extension
NEW: Flu Testing and Treatment
In Home Psychotherapy Reimbursement Update for Non-Physicians
2024-2025 Value-Added Services Update
Effective October 1, 2024: Pharmacy and Biopharmacy PoliciesEffective
December 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash September 10, 2024

Effective 10/1: COVID-19 Vaccine Updates
Authorization of Services that Require the Use of EVV
Training Requirement: Model of Care
REQUIRED: 3 in 30 for Your Patients
ACTION REQUIRED: Rate Enhancement

Provider Newsflash August 27, 2024

IMPORTANT: Co-pays Resuming for Certain Services
Tips to Decrease Emergency Room Visits
Chlamydia Screening Recommendations
Improving Health through Quality Improvement
NEW: Provider Tool for Enhancing Care for those with IDD and Communication Barriers
Effective September 1, 2024: Pharmacy and Biopharmacy
PoliciesEffective November 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash August 13, 2024

Billing: Have a Claim to Process?
Effective 10/31: Medical Necessity Review Criteria Update
REQUIRED: Appointment and Office Site Standards
Critical Reporting Requirements for LTSS Providers
Coming Soon: Provider Satisfaction Survey
Effective October 1, 2024: Pharmacy and Biopharmacy Policies
Effective November 1, 2024: New and Revised Clinical and Code Editing Payment Policies
Effective November 11, 2024: Clinical Policies

Provider Newsflash July 30, 2024

IMPORTANT: Medical Records Retrieval Project
PROHIBITED: Balance Billing
Upcoming Recruitment and Retention Webinar
Provider Satisfaction Survey
BILLING REIMBURSEMENT: Behavioral Health
Effective July 22, 2024: Clinical Policies
Effective September 30, 2024: Clinical Policies
Effective October 31, 2024: Clinical Policies

Provider Newsflash July 16, 2024

IMPORTANT: Co-pays Resuming for Certain Services
Support for Members Affected by Severe Weather
Secure Portal: Manage Tasks Quickly and Easily
Important Resources for Delivering Quality Care
JOIN US: DME Town Hall
Effective June 1, 2024: Elimination of Certain Laboratory Services Payment Policies

Provider Newsflash July 2, 2024

REMINDER: Member Reimbursement
Health Passport Requirements for Behavioral Health Providers
ESRD Eligibility and Evidence Report
Adding Providers to MMH Treatment Network
Behavioral Health Appointment Platform
Effective July 1, 2024: Pharmacy and Biopharmacy Policies
Effective September 1, 2024: Pharmacy and Biopharmacy Policies

Provider Newsflash June 18, 2024

Effective 9/1: STAR+PLUS Contract Changes
HHSC: STAR+PLUS Webinars
Monitoring Needed for Members Taking Antipsychotics
Training Requirement: Model of Care
QUICK! Customize News Preferences Now

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

April 20, 2021 Provider Newsflash

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?

April 6, 2021 Provider Newsflash

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

May 26, 2020 Provider Newsflash

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