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Resources and tools for providers and health care professionals

We invite you to use this website, created especially for health care professionals, to find resources that can help you as you care for your patients. Here you can find our medical policies, stay up to date on the latest news or get training on our many tools and benefit plans.

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News

Expanded list of vendors for EDI 275 unsolicited claim attachments

Now, more clearinghouses can securely submit EDI 275 unsolicited claim attachments. See why it’s better than using mail.

Michigan Medicaid: How to avoid denied community health worker claims

CHW claims denied due to incorrect data and provider non-enrollment are on the rise. Learn how to fix them.

National Minority Health Month: Addressing social drivers of health

SDOH affects the health and well-being of patients in racial and ethnic minority communities. See how to make a difference.

Outpatient Procedure Grouper Exhibit annual reimbursement update

Review the 2026 Outpatient Procedure Grouper (OPG) Exhibit for annual changes to reimbursement.

New Mexico Medicaid: State changes to claims process

New Mexico HCA and MAD are launching a new claims management system this spring. Learn about payer ID updates and more.

Pennsylvania Medicaid: Community health worker certification now required

HealthChoices requires community health worker certification for Medicaid partners as of Jan. 1, 2026.