Category: Medicare
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.
HealthSpring Plans by County
POET staff has done everything short of a full skeletal reconstruction to make the HealthSpring county page in the provider manual legible. They’ve stretched it. They’ve shrunk it. They’ve even converted it to Word and back to a PNG. It just didn’t have the backbone it needed.
If we were tibia honest, nothing worked.
So I, Sir Seymore Bones — resident WordPress writer and part-time osteo-optimizer — took pen in hand (metacarpals and all) to give everyone a little relief. When the formatting started rattling, I decided it was time to get to the bare bones of the issue.
I hope the map below helps you Sey-more, and make sense of the plans offered in our counties. We femur-ly believe this version is better. If it doesn’t… well, I promise I didn’t bone it up on purpose.
Stay humerus,
Sir Seymore Bones
Final 2026 Medicare Conversion Factors: What Providers Need to Know
Understanding the difference between QP and non-QP conversion factors
Each year, the Centers for Medicare & Medicaid Services (CMS) finalizes updates that impact Medicare reimbursement under the Physician Fee Schedule (PFS). One of the most important updates is the Medicare Conversion Factor (CF) — the dollar amount used to convert Relative Value Units (RVUs) into the final payment amount.
For Calendar Year (CY) 2026, CMS finalized two separate conversion factors:
One for Qualifying Participants (QPs) in Advanced Alternative Payment Models (Advanced APMs)
One for Non-Qualifying Participants (Non-QPs)
This distinction is important because it directly affects reimbursement rates depending on a provider’s participation status in the Quality Payment Program (QPP).
Qualifying Participants (QPs)
A provider becomes a QP by meeting specific thresholds for participation in Advanced APMs, such as having a certain percentage of payments or patients through eligible Advanced APM arrangements.
Key point: QPs receive a more favorable conversion factor update than non-QPs.
Non-Qualifying Participants (Non-QPs)
Providers who do not meet QP thresholds—or who participate in MIPS instead—fall into the non-QP category.
Bottom Line:
The Final 2026 Medicare Conversion Factors reinforce a major policy direction: CMS continues to differentiate payment updates based on participation in Advanced APMs.
Understanding whether your clinicians are QPs or non-QPs is essential for accurate reimbursement forecasting and strategic planning.
Conversion Factor:
- $33.57 for qualifying alternative payment model (APM) participants (QPs)
- $33.40 for non-QPs
- An increase of 3.77% for QPs and 3.26% for non-QPs over the 2025 rates
- Includes 0.75% increase for QPs and 0.25 for non-QPs
- 0.49% positive budget neutrality adjustment
- 2.50% increase from the OBBBA for 2026
HealthSpring Provider Manual 2026
Have you received your copy of the HealthSpring Provider Manual?
HealthSpring has a New Payor ID
PAYOR ID: 52192
Claims Address for paper claims: P.O. Box 23456 Chattanooga, TN. 37421
More on HealthSpring and CPL
Update: POET has been advised that the issue involving HealthSpring, CPL, and Polk County is related to a claims system error. HealthSpring has confirmed that they are currently in contract with CPL, and the issue is actively being worked on.
POET we keep you updated, as we receive information.
CPL Labs and HealthSpring
Just in from HealthSpring!
In Polk County, CPL Labs are not in network.
HealthSpring patients in Polk County should go to Quest or LabCorp.
Medicare Beneficiaries Involved in CMS Data Breach
CMS Notifies Individuals Potentially Impacted by Data Incident
Approximately 103,000 beneficiaries may have been impacted.
POET has been told by several offices, they are seeing beneficiaries who have been assigned a new number by CMS.
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