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Complete Your Medicaid Revalidation to Avoid Disenrollment
Texas physicians with Medicaid revalidation applications currently being processed, with deadlines on or before May 31, will be granted extensions ranging from 60 to 180 days, per the Texas Medicaid & Healthcare Partnership (TMHP).
TMHP offers the following online guidance:
- A physician who has not received a previous extension, and has a revalidation due date on or before May 31 is eligible for a first-time revalidation extension of 180 calendar days once the application is submitted (which TMHP labels “in-flight”); and
- A physician with an in-flight revalidation application already submitted and a due date on or before May 31, is eligible for a second extension of 180 days and a third extension of 60 days, plus additional 60-day extensions beyond the third.
The Texas Medical Association advises applicants who haven’t started revalidation yet to check due dates in the Provider Enrollment and Management System (PEMS), and especially if the due date is within 180 days, to fill and send their application promptly.
Also, physicians should note that a draft of an application saved in PEMS is not considered in-flight; it must be completed and submitted to gain in-flight status and thus the second and third extensions. Revalidation is not complete until an applicant’s revalidation request shows it is in “closed-enrolled” status.
Any extensions granted will be reflected in the “revalidation due dates” column on the Provider Information page of PEMS, TMHP says.
Physicians will also receive an email notification confirming their new revalidation due date once an extension is issued.
TMHP grants 165 cumulative business days to address all deficiencies on a revalidation application. If the revalidation application has unresolved issues taking it beyond that window, TMHP will close the application, requiring the physician to submit a new revalidation request.
Through its Physician Payment Resource Center, TMA offers help to physicians unfamiliar with the process or who have specific questions about using PEMS.
Last Updated On:
June 08, 2026
Originally Published On:
April 23, 2026
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.
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