New Mexico Healthcare Authority (HCA) will commence imposing additional claim submission requirements on providers in March. Providers will have to provide the correct taxonomy and ZIP codes on all claims made under the Turquoise Care managed care organizations.
Under the new policy, claims made without a taxonomy code and claims made with an incorrect taxonomy and /or ZIP code will be rejected. Its implementation is in line with the current fee-for-service billing practice of HCA and applies to all providers under the Turquoise Care program in the state.
Turquoise Care has updated its taxonomy crosswalk to accommodate new changes made by the National Uniform Claim Committee (NUCC). Check with the New Mexico Medicaid Portal to ensure that the appropriate taxonomy code is linked with provider enrollment and to confirm that their claims are submitted correctly.
The following requirements should be met by healthcare providers when filing institutional and professional claims:
If you have questions, you can connect to chat 24/7 in the UnitedHealthcare Provider Portal.
The Texas Medicaid & Healthcare Partnership (TMHP) has announced upcoming updates to procedure codes under the Children with Special Health Care Needs (CSHCN) Services Program, effective April 1, 2026.
The changes are based on the first-quarter 2026 revisions to the Healthcare Common Procedure Coding System (HCPCS) issued by the Centers for Medicare & Medicaid Services (CMS). These updates include the addition of new procedure codes, revisions to existing codes, and the discontinuation of certain codes.
Newly added HCPCS codes will not be immediately reimbursable under the CSHCN Services Program. The Texas Health and Human Services Commission (HHSC) must first review the new codes and conduct a rate hearing before reimbursement rates are established. Providers will receive formal notification of any benefit updates in a future publication.
For further assistance, providers may contact the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
The Texas Medicaid & Healthcare Partnership (TMHP) has announced reimbursement rate changes and updates for specific Medicaid procedure codes, effective for dates of service on or after March 1, 2026.
The following topics were covered at the November 10, 2025, public rate hearing:
If you have questions, call 800-568-2413.
Starting February 2026, AARP Medicare Supplement plans from UnitedHealthcare will change how overpayments are handled. When possible, future electronic payments will be reduced by the overpaid amount, so you won’t get separate requests to send the money back.
This update applies only to providers who receive EFT/ACH payments through Optum Pay.
This change applies to claims based on where the service is performed. It will be in effect for services provided in:
| Arizona | Iowa | Nebraska | South Dakota |
| Arkansas | Kansas | Nevada | Texas |
| Colorado | Kentucky | New Mexico | Utah |
| Connecticut | Maine | North Dakota | Vermont |
| District of Columbia | Massachusetts | Oregon | Virginia |
| Georgia | Michigan | Pennsylvania | Washington |
| Hawaii | Minnesota | Rhode Island | West Virginia |
| Idaho | Mississippi | South Carolina | Wisconsin |
| Wyoming |
Right now, if there’s an overpayment, we send a letter telling you how to return the money.
Going forward, we’ll usually take the overpaid amount back by reducing future payments tied to the same tax ID (TIN).
Need assistance? Use the 24/7 chat in the UnitedHealthcare Provider Portal for support.
When a payment is processed in real time, the entire amount is released immediately, instead of following the usual 3–5 business day availability window. This supports timely payment standards, but it does not change your contracted or state-required payment timelines.
To receive real-time payments:
How these payments may appear in bank tools:
If you can’t see extended reference/remittance details, you may need to ask your bank about enabling additional reporting.
You can access these transactions through:
Need assistance? Use the 24/7 chat in the UnitedHealthcare Provider Portal for support.
UnitedHealthcare Community Plan of Massachusetts has updated how dual-eligible coverage works when a Senior Care Options (SCO) or One Care member loses MassHealth Medicaid eligibility.
If a member has lost MassHealth, check their current plan coverage before providing services. Verify eligibility in the UnitedHealthcare Provider Portal.
Tip: If Medicaid shows inactive with an end date, the member may be in the deeming period. In that case, Medicaid-only services won’t be paid.
To get Medicaid back, the member must complete the state redetermination. If approved, coverage starts again on the new effective date set by the state; it won’t be backdated to when it ended.
This includes (but is not limited to):
For members in H2226-003, personal care attendant and adult day health benefits are coordinated between Medicare and Medicaid. During the 60-day deeming period, these members may be able to continue receiving limited services, including certain wraparound services (as allowed under plan rules).
Medicare benefit will cover 13 hours (52 units) per month.
| Fiscal intermediary | |||
| Description | Service code | Modifier | Allowable covered units |
| Personal care services, per 15 mins | T1019 | No modifier, U5, U6, U7, U9, UA | 52 units per month |
| Personal care task fee | T1020 | 60 days max | |
| PCA PTO earned time | 99509 | U2 | 52 units per month |
| PCA new hire orientation | 99509 | U3 | 1 unit per month |
| Complex care rate | T1019 | TG | 52 units per month |
| Personal care management agency | |||
| Description | Service code | Modifier | Allowable covered units |
| PCA skills training | T2022 | No modifier, U1, U2, U3, U4, U5 | 4 units per month |
| PCA screening, intake, and orientation | T1023 | 3 units per month | |
Medicare benefits will cover the first 19 days per month.
| Adult day health | |||
| Description | Service code | Modifier | Allowable covered units |
| Day care services | S5101 | No modifier, TG | 19 units per month |
| Day care services | S5102 | No modifier, TG | 19 units per month |
| Non-wheelchair transport | T2003 | 38 units per month | |
| Wheelchair transport | T2003 | U6 | 38 units per month |
SafeRide is covered as a Medicare benefit under the SCO plan benefit package H2226-003 for trips up to 50 miles. This coverage does not apply during the deeming period for SCO PBP001 or for either One Care plan.
During the 60-day Medicare deeming period, Medicaid-only services are not covered or paid for.
Reminder: Services that are not covered by Medicare will not be reimbursed during the deeming period.
From March 01, 2026, MTM Health will take over non-emergency medical transportation (NEMT) for UnitedHealthcare Community Plan of Florida members. This includes rides to covered care such as doctor appointments, pharmacies, hospitals, and other approved services.
MTM can also handle ride requests from clinics, facilities, and health care teams.
Need help or more details? Check the MTM Health reservations information, or use the 24/7 portal chat for support.
Georgia commercial health plan providers should review important updates regarding out-of-network services, non-covered services, balance billing requirements, and new prescribing rules for SHBP members effective February 2026.
“Nonparticipating health care providers (all commercial plans)”.
Before providing a non-covered service:
This helps prevent unexpected charges and keeps documentation in order.
For Georgia State Health Benefit Plan (SHBP) members enrolled in a UnitedHealthcare HMO or a high-deductible health plan (HDHP):
If an SHBP member currently has an active prior authorization for a weight-loss medication, they will be instructed to enroll with 9amHealth once that authorization ends. Please direct members who need weight-loss medications to:
Note: SHBP has already notified affected members and asked them to enroll with 9amHealth. Please remind members as needed, so their treatment continues without delays.
CMS issues policies to reduce health care expenses, increase consumer choice, and safeguard taxpayers.
As of today, the Centers for Medicare and Medicaid Services (CMS) offered regulations to reduce healthcare costs, competition, and enhance program integrity within the Federal and State-Based Health Insurance (Exchanges). The 2027 Notice of Benefit and Payment Parameters would crack down on fraud and misleading practices in the agent and broker industry, would reform accountability over taxpayer-funded subsidies, would eliminate federal barriers that have hindered plan innovation and increased premiums, and would help ensure coverage is more affordable and works better in serving consumers, taxpayers, and states. The overall goal is to make Exchange coverage more affordable and more effective for consumers, taxpayers, and states.
“At President Trump’s direction, HHS is focused on reducing costs and eliminating fraud across our health insurance programs,” said Health and Human Services Secretary Robert F. Kennedy, Jr. “This proposal is intended to lower premiums, increase consumer options, crack down on fraud, and support coverage designs that emphasize prevention and long-term health.”
This proposal places patients, taxpayers, and states at the forefront, therefore reducing costs and strengthening accountability on taxpayer funds, said CMS Administrator Dr. Mehmet Oz. We are cracking down on inappropriate and deceptive practices and providing states and health plans with more space to be creative and competitive. The objective is not complicated: reduced prices, increased options, and exchanges that are functioning as intended.
The rule suggested promotes new, consumer-oriented plan designs, enlarging choice and facilitating affordability. If finalized, the rule would:
CMS is also proposing tougher eligibility and income verification requirements, along with stronger enforcement, to ensure premium subsidies are provided only to eligible individuals. The agency says expanded income checks would help reduce improper enrollments, prevent unauthorized plan changes, and limit fraud across the exchanges. The proposal also updates Exchange policies to reflect legal requirements that restrict eligibility for premium tax credits, cost-sharing reductions, and advance payments of those benefits to individuals who meet immigration eligibility standards, and it would require Exchanges to verify that eligibility.
Another effect of the proposed rule is that it enhances the standards of behavior of insurance agents, brokers, and web brokers by illuminating the unacceptable marketing activities and promoting supervision to discourage fraud and deceptive behaviors. The following measures will help strengthen the trust people have in the exchanges and safeguard consumers against malicious entities.
CMS also suggests modifications to make the Exchange policy more consistent with statutory intent and responsive to important cost drivers, such as:
These reforms will help reduce premiums and provide greater access, while giving consumers more control over their health coverage.
The Trump administration continues to fulfill its commitment to independent, competitive, and affordable health insurance markets and hold federal programs accountable with integrity. CMS is open to the feedback of the public on the proposed rule and anticipates collaboration with the states, issuers, agents, brokers, and interested parties to conclude on the policies that place patients and taxpayers in the first place.
To check out the proposed rule, visit https://www.federalregister.gov/d/2026-02769.
Public comments must be submitted by March 11, 2026.
To review the proposed rule fact sheet, visit https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule.
The Office of Inspector General (OIG) has published its long-awaited Medicare Advantage Industry Segment-Specific Compliance Program Guidance (MA ICPG). It is the first significant change in the Medicare Advantage (MA) program in over 25 years. The new guidance indicates the dramatic growth, complexity, and heightened regulatory scrutiny of the MA program and also the increased compliance expectations for not only the MA plans but also health care providers and other participants in the program.
Although the MA ICPG is voluntary and nonbinding, it identifies compliance risk areas and gives detailed and practical recommendations that will help minimize fraud, waste, and abuse. Importantly, OIG makes clear that providers participating in MA networks are now firmly within the compliance spotlight.
One of the main topics of the guidance is enhanced control over the First Tier, Downstream, and Related Entities (FDRs), including providers and their subcontractors. OIG reiterates that MA plans are ultimately responsible for the actions of their FDRs and encourages plans to implement more proactive monitoring, auditing, and compliance oversight practices.
The guidance suggests dedicated oversight teams for providers, including oversight of network adequacy, quality data and analytics, coding audits, and utilization management case logs.
OIG also urges MA plans to investigate any suspected misconduct internally and refer the misconduct to law enforcement where necessary. Consequently, providers are likely to receive increased scrutiny of operations and of any downstream subcontractors, including IT providers and overseas partners.
OIG highlights risk adjustment as a high-risk area, citing concerns over:
The guidance recommends that MA plans implement sophisticated data analysis, such as artificial intelligence applications, to determine the quality of data submitted by providers. Such steps will result in a higher number of requests for medical records and more audits. Providers having good documentation practices, diagnosis validation processes, and internal compliance control will be in a better position to respond to these reviews.
The MA ICPG further discusses the lack of network adequacy and provider directory accuracy, warning that administrative sanctions can be imposed on the shortcomings of MA plans in these areas. Greater adherence would be beneficial since it would increase chances of participation in the network and enhance patient access.
Simultaneously, the providers can face tighter contractual requirements regarding the timely update of the roster. This remains a risk area because failure to meet the directory accuracy requirements has led to payment reductions and claim denials in the past.
The dominant area of enforcement is marketing. Although much of the guidance is directed at MA plans and marketing organizations, OIG cautions against arrangements where providers are compensated to refer patients to certain MA plans. The guidance uses the example of OIG’s 2024 Special Fraud Alert on MA marketing, highlighting existing issues with provider participation in inappropriate MA-related marketing.
The new guidance issued by OIG clarifies that compliance responsibility in the MA program goes far beyond the health plans. Providers should expect more frequent audits, increased data requests, and additional compliance requirements from MA plans.
Providers can manage risk by enhancing internal controls, improving documentation quality, and paying close attention to relationships with subcontractors. This will help them navigate the increasingly regulated Medicare Advantage environment.
