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TMB
New CME Tracking Requirement
AN IMPORTANT UPDATE REGARDING YOUR LICENSE RENEWAL REQUIREMENTS
Due to recent legislation enacted by the Texas Legislature, all health care practitioners in Texas will be required to have their continuing education compliance verified through a CE tracking system prior to license renewal. This requirement is mandated by state law.
To meet this requirement, the Texas Medical Board (TMB) has partnered with CE Broker as the official CE tracking platform. ALL TMB licensees should, at a minimum, establish a free, basic account with CE Broker.
Beginning September 1, 2026, licensees renewing their license must:
- Have an active CE Broker account (basic accounts are free)
- Ensure all completed continuing education is reported in CE Broke
If the Texas Medical Board cannot verify CE compliance through CE Broker, you will not be able to complete your license renewal.
Upcoming Informational Webinar
To support licensees through this transition, TMB—along with CE Broker—will be hosting a series of informational webinars providing a practical, step-by-step tutorial on using CE Broker to track, manage, and report CME, supporting audit readiness and ongoing compliance.
Audience: Physicians
Date: Wednesday, May 13, 2026
Time: 12:00–1:00 PM CT
Registration is limited to 1,000 participants so please sign up as soon as possible to secure your spot. Registration will remain open until all spots are filled.
HS
Updates for HealthSpring providers | |
We’re changing prior authorization requirements that may apply to some HealthSpring Medicare Advantage members. Changes are based on updates from utilization management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System code changes from the Centers for Medicare & Medicaid Services. For some services and members, prior authorization may be required through HealthSpring utilization management, and related services for Medicare Advantage members will be reviewed by HealthSpring and EviCore healthcare. | |
These changes begin July 1, 2026: · Implementation of Part B Step Therapy Program · Addition of orthotic codes to be reviewed by HealthSpring · Addition of new Medicare Advantage Prescription Drug plan codes to be reviewed by HealthSpring | |
For more information, refer to the prior authorization requirements list on the clinical review page. Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, and the terms of the member’s evidence of coverage. If you have any questions, call the number on the member’s ID card. Services performed without required prior authorization or that do not meet medical necessity criteria may be denied for payment, and the rendering provider may not seek reimbursement from the member. | |
Thank you for your partnership. | |
CPT copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA. | |
HealthSpring products and services are provided exclusively by or through operating subsidiaries of Health Care Service Corporation, a Mutual Legal Reserve Company. PO Box 20002, Nashville, TN 37202 © Copyright 2026 Health Care Service Corporation. All Rights Reserved. |
Arcadia 360 User Guide 4/2/26, HealthSpring
Effective 4/2/26, in accordance with HCSC’s coding policies and guidelines, the Arcadia 360 and Arcadia HMR have been updated to account for the required documentation of specified medications within the treatment plan of active conditions.
- Arcadia 360: upon selecting Active Condition in the 360, a “notes” field will appear. It will be required in addition to the one word treatment plan.
- If an end user selects “Medication” as the treatment plan, the notes field should be used to document the specific medication being used as treatment for that specific condition.
- If an end user selects any other option as the treatment plan, the notes field should be used to provide more MEAT criteria to substantiate the condition being actively treated.
- Arcadia HMR: the medication should be written in along with the selected treatment plan at the condition level. Instructions have been added to the HMR footer indicating this change beginning with the April run of the HMRs.
If you have any questions, please reach out to your HealthSpring Coding Educator for additional information and instruction. POET has reached out for this information.
Superior PCP Change Request Form
I didn’t know?
How was I supposed to know?
We all know it is going to happen. The PCP on the card is not yours. And know one knew.
But Superior has made it a little easier. No setting on hold.
Help the patient fill it out.
For Star Health, fax the completed form to (866) 626-6069.
For all others, fax to (866) 918-4447.
HealthSpring Change in Prior Auths
Change in prior authorization administration for DME services, effective March 1, 2026 |
Effective March 1, 2026, HealthSpring will manage prior authorizations for durable medical equipment services, as well as orthotic and prosthetic codes. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.
EviCore healthcare will continue to manage prior authorizations for DME services through Feb. 28, 2026.
What this means to your patients through Feb. 28, 2026 · Submit prior authorization requests with dates of service before March 1, 2026, to EviCore as usual. · Continue to refer to EviCore for the most updated prior authorization code lists. · There are no changes to the claims submission or appeals processes.
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Key changes effective March 1, 2026 · DME providers will submit prior authorization requests directly to HealthSpring. · Submit prior authorization requests to HealthSpring for dates of services beginning March 1, 2026. Request prior authorization through Availity Essentials™, our provider portal. · A list of procedural codes requiring prior authorization is available on the clinical review page of our provider website, HealthSpring.com/Providers. · Any authorization issued prior to March 1 will remain valid for those dates and services. That means, any authorizations approved by EviCore before March 1 will remain effective with HealthSpring. You do not need to submit a new prior authorization request.
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How to request prior authorization Request prior authorization through our provider portal, Availity Essentials. This portal is the preferred and fastest method. Refer to Availity for instructions on setting up an account and navigating the portal. If you prefer, you can also call 1-800-914-8252 or fax 1-877-451-5541. |
Who Would’ve Thought?
Novitas Training on YouTube!
Novitas has made learning more convenient by offering helpful tutorials on YouTube. These short videos provide quick guidance on common Medicare topics, making it easier to find answers without having to attend a full webinar.
ERISA or maybe TPA?
Let’s play pretend:
Some one gives you this card and wants to make an appointment.
They seem to want an answer right now.
You know your physician takes Blue Choice, but have never seen this card before. How would you know?
Look at the front of the card. Blue Cross is written all over it. BCBS must be the insurer? STOP!
Do you see any insurance regulation language? Is “TDI” or “DOI” on this card?
NO. This is your 1st clue. The employer may be the insurer.
Scan the front of the card intently. Are there any other clues. Look for what you know, not what you don’t know.
If not flip it over. What do you see? READ ALL THE TINY WRITING.
On this card: phone numbers, addresses, where to file, prior auth info. But what else?
“This coverage is self-funded Excellus BlueCross BlueShield, and independent licensee of the BlueCross BlueShield Association provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims.”
What does that mean:
- The employer is the insurer (self-funded plan)
- Excellus BCBS is acting as a Third-Party Administrator (TPA)
Is this a Lease Network?
Very likely — yes.
On the front of the card it says:
“To verify participation, please call the BlueCard Provider Network.”
That suggests:
- The plan is using the BlueCard network
- Excellus is providing network access + claims processing. The employer is leasing the BCBS network
That’s what we commonly call a lease network arrangement.
But — this is important — don’t assume, Verify
Why you may still get a “Yes” when you call
When you call provider services:
- The rep may simply see “In Network”
- They may not understand lease networks
- They may not understand the difference between:
- Payor
- TPA
- Repricer
- Network administrator
So we need to ask better questions.
Instead of just asking “Is Dr. Smith in network?”
Tell the representative you would like to check network participation.
Ask:
- Is this plan self-funded? (if it is self-funded it is not a lease network)
- Is Excellus the payor, or the administrator?
- Is this a leased network?
- Who bears the financial risk?
- Is Excellus repricing the claims?
- What network applies to this patient?
And always get:
✔ Representative name
✔ Date/time
✔ Call reference number
If the claim denies, that reference number becomes your leverage.
Why this matters
In lease network plans:
- The employer controls the benefits.
- The employer may carve out services.
- The employer may override network rules.
- The plan can be patient-specific.
Basically they can make up their own rules.
In practical terms — They have more flexibility than a fully insured DOI-regulated plan.
Protect Yourself when speaking to the patient.
Never speak in absolutes.
Use language like:
- “It looks like this is a self-funded plan…”
- “Based on the card wording…”
- “According to the representative I spoke with…”
- “At the time of verification…”
Never say:
- “Yes, you are definitely covered.”
- “This will pay.”
- “You are in network.”
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