NEW BCBSTX fee schedule coming
ATTENTION PROVIDERS
BCBSTX has notified POET that a NEW Fee Schedule for Blue Choice and Blue Essentials will be effective May 1, 2026.
Once POET receives the new fee schedule and completes its review, OPT-IN / OPT-OUT packets will be sent to physician offices for participation decisions.
Please watch for additional communication once the review process is complete
UHC Community Plan Policy Update Feb. 2026
For a comprehensive summary of the latest updates, refer to the Medical Policy Update Bulletin: February 2026
Medical Policy Updates:
Medical Benefit Drug Policy Updates:
What is an EPO
In health insurance, an EPO is an Exclusive Provider Organization plan.
Here’s what that means in practical terms:
What an EPO plan is
You must use doctors, hospitals, and facilities in the plan’s network
👉 Except for true emergenciesYou do not need a referral to see a specialist
Care received outside the network is not covered at all (again, except emergencies)
Pros of an EPO
Usually lower monthly premiums than PPO plans
No primary care referral requirement
Simpler than HMO plans
Cons of an EPO
No out-of-network coverage
Limited flexibility if you travel a lot or want a specific doctor who isn’t in-network
How EPO compares to other plans
EPO vs PPO: PPO allows out-of-network care (at higher cost); EPO does not
EPO vs HMO: HMO usually requires referrals; EPO does not
Disclaimer: The information provided in this blog is for general educational purposes only. While Ink strives to explain insurance concepts accurately and clearly, payer rules, contracts, and policies can vary widely by plan, state, and provider agreement—and they change frequently.
This content should not be interpreted as definitive guidance or a substitute for reviewing payer manuals, contracts, or official communications. Physician offices are encouraged to conduct their own research and verify requirements directly with the applicable insurance carriers before making operational or billing decisions.
HealthSpring Provider Manual 2026
Have you received your copy of the HealthSpring Provider Manual?
Employer Group PPO/EPO Hybrid
Interpreting insurance cards has never been easy, but with the constant changes in today’s insurance landscape, it has become nearly impossible.
Every week seems to bring a new insurance company—or an established insurer that has acquired several others, rebranded, and rewritten the rules.
On top of that, there are hybrid plans like POS and EPO, along with discount cards, medical cost-sharing programs, limited-benefit plans, and the growing model of Direct Primary Care.
The one pictured below is an ultimate example!
It takes hybrid to a new level of complexity.
By mixing the rules of PPO and EPO in one plan.
Therefore, I, Sir Seymore, have taken my red pen in hand in an effort to make sense of it all.
Feel free to download this card for your records.
CLIA-Checks No Longer Accepted
Per CMS CLIA Communications Update: This is your last chance to go paperless before we eliminate paper fee coupons and CLIA Certificates on March 1, 2026. In addition, laboratories must pay their CLIA certification and survey fees online (checks will no longer be accepted). Failure to go paperless may result in billing or certification issues.
When you switch to paperless, your laboratory will get:
• Email notifications from CMS
• Electronic fee coupons*
• Electronic CLIA certificate – no more waiting for it to come in the mail*
*This does not apply to CLIA-exempt states or state licensure.
To switch, you must either:
• Email your State Agency
Tip: Include your laboratory name, laboratory director or owner’s name, CLIA number, director or designee’s signature to help your State Agency make the switch.
• Contact your Accreditation Organization (for accredited labs).
They can add or update email addresses for the laboratories they survey.
Reach out to your State Agency or Accreditation Organization for assistance. For more details, visit Clinical Laboratory Improvement Amendments (CLIA).
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.
UHC December Monthly Overview
Key changes for our Medicare Advantage plan
- In 2026, most UnitedHealthcare Medicare Advantage health maintenance organization (HMO) and point of service (POS) plans are referral plans. You can check plan referral requirements online.
- Starting Jan. 1, 2026, most members enrolled in UnitedHealthcare Medicare Advantage HMO/POS plans will be required to obtain a referral from their primary care provider (PCP) before accessing certain specialist services in outpatient, office or home settings. Referrals must be submitted by the PCP to UnitedHealthcare prior to the specialist visit. This also applies when members of HMO/POS plans are traveling and accessing the National Network. Learn more in our 2026 Medicare Advantage Referral Requirements Guide.
- Effective Jan. 1, 2026, new or existing members of UnitedHealthcare SNPs, including Chronic Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP), need a qualifying chronic condition to access benefits that cover healthy food and/or utilities. Providers may be contacted by UnitedHealthcare to verify a member has at least one qualifying condition to receive benefits. See 2026 Medicare Advantage, CSNP & DSNP Plan Overview Course for more information.
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