The Texas Medicaid & Healthcare Partnership (TMHP) has announced updated reimbursement rates for select Healthcare Common Procedure Coding System (HCPCS) procedure codes under Texas Medicaid. These changes will take effect for dates of service on or after January 1, 2026.
The revised reimbursement rates apply across multiple service categories. Providers can review detailed changes through official TMHP spreadsheets covering:
TMHP will automatically identify and reprocess claims impacted by these reimbursement updates. Any resulting adjustments in payment amounts will be reflected in upcoming Remittance and Status (R&S) reports, ensuring providers receive corrected reimbursements without requiring resubmission.
While these updates apply to traditional fee-for-service Medicaid, providers should note that Medicaid managed care organizations (MCOs) operate under separate administrative procedures. Requirements such as prior authorization, referrals, and claims submission may vary between MCOs.
Healthcare providers are advised to contact the specific MCO associated with a member for detailed guidance on administrative processes and coverage policies.
For further assistance or clarification, providers can contact the TMHP Contact Center at 800-925-9126.
The Michigan Department of Health & Human Services (MDHHS) has issued an important reminder to Federally Qualified Health Centers (FQHCs) regarding billing requirements for Community Health Worker (CHW) services. The advisory comes amid a noticeable rise in claim denials attributed to incomplete, inaccurate, or duplicate submissions.
To ensure successful reimbursement and avoid denials, providers must include the following mandatory details on the UB-04 claim form:
MDHHS also highlighted several key submission practices to prevent avoidable denials:
Providers seeking assistance can access 24/7 support through the UnitedHealthcare Provider Portal, which offers chat-based help and additional claims submission guidance.
North Carolina Medicaid has reiterated its requirement for Personal Care Services (PCS) providers to comply with Electronic Visit Verification (EVV) standards, reinforcing strict data submission protocols and compliance expectations. The directive applies to providers serving beneficiaries under both Standard Plans and Tailored Plans, with a continued mandate to use HHAeXchange as the official platform for EVV data transmission, particularly for transactions involving UnitedHealthcare.
Under the updated guidance, PCS providers must ensure accurate and real-time documentation of service encounters. This includes:
Failure to comply with these documentation requirements may result in denied claims and potential audit actions.
The state has emphasized that EVV data must be transmitted electronically via HHAeXchange. Providers submitting claims directly to UnitedHealthcare without routing EVV data through the approved vendor will be considered non-compliant, leading to automatic claim denials.
Additionally, providers must ensure:
Only a single submission is required, as HHAeXchange will forward both EVV and claim data to UnitedHealthcare for processing.
To meet compliance standards, providers must:
These steps are essential for proper system integration and adherence to state requirements.
North Carolina Medicaid has also outlined key compliance measures:
While manual entry of visit data is permitted, it is capped at 15%. The state actively monitors these submissions, and excessive manual entries may trigger scrutiny.
Non-adherence to EVV requirements, including failure to follow the approved service plan, may result in Program Integrity audits. Such violations could also impact future service authorizations and the continuation of PCS services.
Providers can access additional guidance through official Medicaid policy documents and the 2026 Care Provider Manual. For assistance, support is available via the UnitedHealthcare Provider Portal or through HHAeXchange technical support channels.
UnitedHealthcare has announced significant enhancements to its Onboard Pro platform, introducing bulk submission capabilities for provider credentialing. This update is designed to simplify, accelerate, and standardize the onboarding process for healthcare organizations.
The new feature, now available within the UnitedHealthcare Provider Portal, enables organizations to submit credentialing applications for up to 50 providers simultaneously. It also supports multi-state processing, allowing credentialing in up to 10 states per bulk submission.
For more information, visit the UnitedHealthcare Provider Portal at uhcprovider.com or refer to the Onboard Pro interactive guide.
The Centers for Medicare & Medicaid Services (CMS) has announced a six-month nationwide temporary moratorium on the enrollment of new Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers into the Medicare program. The action was published in the Federal Register on February 27, 2026, and takes effect immediately.
According to CMS, the moratorium follows a detailed review of enrollment patterns and claims data, revealing ongoing program integrity vulnerabilities within the DMEPOS sector. The agency cited persistent risks of fraud, waste, and abuse tied to certain equipment categories and supplier activities.
CMS exercised its statutory authority under the Affordable Care Act and corresponding Medicare regulations, which permit temporary enrollment moratoria in provider or supplier categories where there is a significant risk of fraud, waste, or abuse. The moratorium applies nationwide and affects only new DMEPOS suppliers seeking Medicare enrollment after the publication date.
Existing Medicare-enrolled DMEPOS suppliers are not impacted and may continue billing as usual. The moratorium does not restrict administrative updates, practice location changes, or ownership changes that do not require new enrollment under 42 C.F.R. § 424.570. Applications received prior to the effective date are generally permitted to proceed.
CMS noted that similar moratoria could extend to Medicare Advantage or Medicaid/CHIP providers in certain cases unless a state determines that access to care would be compromised.
CMS and the HHS Office of Inspector General (OIG) referenced multiple historical investigations identifying improper billing schemes and systemic weaknesses in DMEPOS oversight. Particular concern was raised over high-risk equipment categories, including braces, catheters, and other off-the-shelf products frequently associated with fraudulent billing patterns.
Federal officials characterized the action as part of a broader shift from what they described as a “pay-and-chase” enforcement model toward proactive fraud prevention. HHS Secretary Kennedy stated that CMS is leveraging advanced data analytics and artificial intelligence tools to detect suspicious billing before payments are issued. CMS Administrator Oz described the moratorium as a preventive measure aimed at blocking high-risk suppliers from entering the Medicare program at the outset.
Under federal law, CMS may impose moratoria in six-month increments. The current moratorium will remain in effect for six months but may be extended if CMS determines that program integrity concerns persist. Any extension or termination will require publication of a subsequent Federal Register notice.
Organizations planning to enter the Medicare DMEPOS market should anticipate enrollment delays and reassess operational timelines. Industry stakeholders are advised to carefully evaluate whether their services fall within the moratorium’s scope.
Existing DMEPOS suppliers should expect continued oversight and heightened scrutiny of billing practices, documentation standards, and compliance programs. The action signals broader enforcement priorities that could affect other provider categories if similar risks are identified.
The moratorium was announced alongside a CMS Request for Information (RFI) under the agency’s Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. Through CRUSH, CMS is soliciting stakeholder input on additional regulatory and operational measures to enhance fraud prevention across Medicare, Medicaid, CHIP, and the Health Insurance Marketplace.
The RFI indicates potential future rulemaking focused on expanded enrollment controls, improved data transparency, advanced analytics deployment, and stronger coordination with state agencies and law enforcement.
Together, the DMEPOS moratorium and the CRUSH initiative reflect a coordinated federal effort to strengthen healthcare program integrity through both immediate enforcement actions and longer-term regulatory reforms.
CMS has advised stakeholders to monitor upcoming Federal Register notices and agency communications for further developments during the moratorium period.
UnitedHealthcare has announced that beginning June 1, 2026, Synapse Health will manage the durable medical equipment (DME) ordering and fulfillment process for its Individual Medicare Advantage plans and Chronic Special Needs Plans (C-SNP) in Florida and Mississippi.
The update does not apply to:
UnitedHealthcare stated that the transition is part of an effort to improve the overall experience for ordering physicians, DME suppliers, and members. The expansion builds upon an existing capitated agreement and reflects provider and member feedback aimed at modernizing the DME ordering and fulfillment process.
Starting June 1, 2026, physicians and other prescribers must submit DME orders through the Synapse Health e-prescribing portal.
Synapse Health representatives will contact prescribers in the coming months to provide additional information, offer personalized training sessions, and share access to self-service resources.
For members requiring ongoing DME services after the effective date, Synapse Health will coordinate with current DME providers to maintain continuity of care or facilitate transitions when necessary. In some cases, prescribers may be asked to submit updated documentation or new orders to support continued treatment plans.
DME suppliers must join the Synapse Health network to continue providing standard DME services to most UnitedHealthcare Medicare Advantage members in the affected states.
Synapse Health will reach out directly with network participation details. Providers may also inquire about enrollment by emailing JoinOurNetwork@synapsehealth.com.
The following standard DME and mail-order supplies will be managed under Synapse Health:
Providers and members seeking further details may visit the Synapse Health website or contact customer support at 888-336-9363.
UnitedHealthcare has confirmed that UnitedHealthcare Choice Plus is in network for the New York City Employees PPO (NYCE PPO) Plan, expanding clarity for providers serving New York City employees, pre-Medicare retirees, and their eligible dependents nationwide.
The NYCE PPO Plan is available across all U.S. states and provides access to a multi-network structure that includes the following:
The plan is designed to offer comprehensive medical and behavioral health coverage to eligible New York City employees and retirees.
Provider reimbursement under the NYCE PPO Plan depends on the service location and network alignment:
Reimbursement rates apply for covered medical services delivered within the following 13 downstate New York counties:
Reimbursement rates apply for covered medical services provided throughout the United States, except within the 13 downstate New York counties listed above, where EmblemHealth Bridge Program rates govern.
Reimbursement rates apply for covered behavioral health services nationwide, including within the 13 downstate New York counties.
EmblemHealth Bridge Program, UnitedHealthcare Choice Plus, and United Behavioral Health share the same Electronic Data Interchange (EDI) payer ID codes. Providers and clearinghouses must ensure the following configurations:
Providers are encouraged to confirm their clearinghouse setup to prevent claim processing delays.
Regardless of network affiliation—EmblemHealth Bridge Program, UnitedHealthcare Choice Plus, or United Behavioral Health—providers must use the NYCE PPO provider portal for all plan-related transactions.
The portal supports:
Notably, the UnitedHealthcare Provider Portal and the UMR Provider Portal do not provide access to the NYCE PPO plan or member information.
Providers seeking assistance may contact the following:
The Texas Health and Human Services Commission (HHSC) has issued a formal reminder to providers regarding upcoming enrollment deadlines for State Fiscal Year (SFY) 2027 participation in several Directed Payment Programs (DPPs) and the Quality Incentive Payment Program (QIPP). Providers are advised that no deadline extensions will be granted.
The enrollment period for SFY 2027 participation in the following programs will close on March 5, 2026, at 5:00 p.m. CST:
HHSC emphasized that enrollment submissions must be completed by the stated deadline. Late submissions will not be accepted except under specific system-related circumstances outlined below.
The enrollment period for the SFY 2027 Quality Incentive Payment Program (QIPP) will close on March 18, 2026, at 5:00 p.m. CST. No extensions will be provided.
HHSC acknowledged that a significant number of users of the State of Texas Electronic Provider System (STEPS) are currently experiencing technical issues that have hindered enrollment completion.
Specifically, HHSC is aware of a data synchronization issue affecting providers attempting to update their Primary Entity Contact (PEC) information within PEMS. In response, HHSC will permit enrollment submission after the deadline only for providers who meet strict criteria.
HHSC clarified that providers who did not attempt to complete enrollment or failed to report a qualifying system issue prior to the deadline will not be granted additional time.
All tickets will be reviewed in the order received, and determinations will be made based on the outlined eligibility criteria.
HHSC also issued several operational reminders:
HHSC expressed appreciation for providers’ continued cooperation and encouraged timely completion of enrollment requirements to ensure uninterrupted participation in SFY 2027 programs.
You can email your questions to these email addresses
Massachusetts Medicaid has announced major changes that will affect home health care provision under Senior Care options (SCO) and One Care plans, effective from January 1, 2026.
Under the revised policy, prior authorization will not be required for Medicaid home health services unless a member exceeds established annual benefit limits set by MassHealth. Providers will have to seek prior authorization for services exceeding the following calendar-year limits:
| Service | Annual benefit limit |
| Visits for intermittent skilled nursing and/or medication administration | 30 visits |
| Home health aide | 240 units |
| Physical or occupational therapy visits | 20 visits |
| Speech‑language therapy visits | 35 visits |
In alignment with the Centers for Medicare & Medicaid Services (CMS) and state regulations, Massachusetts Medicaid now requires the exclusive use of HCPCS G codes for home health nursing therapy services and home health aide services that support activities of daily living.
Home health agencies are not obligated to submit individual HCPCS codes in either requesting prior authorization or submitting claims, as they are coded to the individual revenue codes and G codes within the UB bill type:
| Service | UnitedHealthcare bill type | Revenue code | G code |
| Physical therapy | UB | 0421 | G0151 |
| Occupational therapy | UB | 0431 | G0152 |
| Speech therapy | UB | 0441 | G0153 |
| Medical social services | UB | 0561 | G0155 |
| Home health aide | UB | 0572 | G0156 |
| Home health aide | UB | 0572 | G0156UD |
| Nursing services – Skilled nursing (registered nurse) | UB | 0551 | G0299 |
| Nursing services – Skilled nursing (registered nurse) | UB | 0552 | G0299UD |
| Nursing services – Skilled nursing | UB | 0551 | G0493 |
| Nursing services – Licensed practical nurse | UB | 0581 | G0300 |
| Nursing services – Licensed practical nurse | UB | 0582 | G0300UD |
Some members now have new subscriber identification numbers. Using an outdated number may result in claim rejections.
You can confirm the correct subscriber identification number:
You can request the updated policy number directly from the member.
If you have questions, you can connect to chat 24/7 in the UnitedHealthcare Provider Portal.
New Mexico Health Care Authority (HCA) and its Medical Assistance Division (MAD) have stated an upcoming update to the state Medicaid claims processing system. In the late spring, the state will release Turquoise Claims as a new claims management platform that will operate through the YES.NM.gov. The state has already informed contracted providers of the transition plans, and they will be notified even further before the actual date of launch.
As part of the transition to Turquoise Claims, the payer ID code for UnitedHealthcare Community Plan of New Mexico will change on the day the new system goes live. To prevent claim denials and delays in processing, the providers are encouraged to follow the following steps:
Providers should contact the clearinghouse to add payer ID 87748 to their list of electronic data interchange (EDI) transactions.
When submitting claims, enter the following payer ID:
The claims submitted with the wrong payer ID in the targeted timelines will be rejected, and providers are required to be correct and resubmit the claim.
UnitedHealthcare has also reported that it will issue a reminder when the state verifies the actual start date.
No changes are made to the process of claims submission except that the code of the payer ID is updated. The providers are expected to make claims using the methods currently in place, such as:
All questions related to EDI are to be addressed to the clearinghouses directly.
