Superior HealthPlan is implementing a new policy on Leveling of Care for office based Evaluation and Management Over-coding (CC.PP.066) Nurse adjusting IV drip to ensure proper care level What Superior Leveling of Care Means Superior will implement an automated pre-payment claims review process to assess and standardize the correct level of evaluation and management (E&M) service effective February 1, 2026. The coding algorithm will analyze each diagnosis code billed on the c

The Blue Cross Blue Shield (BCBS) network is rolling out a significant update that affects how professional providers bill for psychiatry and psychotherapy services. Starting December 22, 2025, a new Clinical Payment and Coding Policy, CPCP051 Psychiatry/Psychotherapy Services-Professional Provider , will take effect. This policy aims to clarify billing and coding procedures for behavioral health services, ensuring smoother claims processing and reimbursement. This update is

Remote Patient Monitoring (RPM) has become a vital tool in healthcare, allowing providers to track patients’ health data outside traditional settings. However, UnitedHealthcare (UHC) announced new restrictions on RPM services starting in 2026. These changes will affect how healthcare providers deliver care and how patients access remote monitoring. Understanding these restrictions is essential for healthcare professionals preparing for the evolving landscape. UHC's 2026 RPM r

Starting January 1, 2026, Superior HealthPlan will introduce an aligned Dual Special Needs Plan (D-SNP) in Texas. As per CMS directives, our current STAR+PLUS Medicare-Medicaid Plan (MMP) will end on December 31, 2025. Members will be automatically transferred to the new aligned D-SNP, named Wellcare By Superior HealthPlan . Similar to MMP, this new plan is crafted for individuals eligible for both Medicare and Medicaid, enabling a single healthcare organization to coordinate

As healthcare providers brace for the changes in Medicare, the new prior authorization requirements coming in 2026 have generated considerable conversation. The initiative known as the WISeR Model seeks to simplify the authorization process while tackling significant issues like fraud and overutilization in specific service areas. It is vital for healthcare providers, especially those in the six states participating in the pilot program, to grasp how these changes will affect