Save Time on Prior Authorizations in Availity^® Essentials

Providers can save time on prior authorization requests and submitting claims with our self‑service provider portal, Availity Essentials.

Take Note of Prior Authorization Changes

We’ve updated prior authorization requirements for some Medicare Advantage members to reflect new, replaced or removed codes. Learn about changes effective Aug 1, 2026, and Oct. 1, 2026.

Clearinghouses Should Submit Claims to HealthSpring

To prevent delays in claims processing, clearinghouses should submit claims via the HealthSpring Medicare Advantage payer space in Availity Essentials using payer ID 52192.

Referrals Aren’t Required for Most Members to See Specialists

For most of our members, referrals from primary care providers aren’t required for outpatient visits with specialists. Referrals are only required for Medicare Advantage HMO members to see in-network specialists in Central and South Florida, Nevada, Oklahoma and Texas.

If You Accept Medicare, You Can See Our PPO Members

If you’re a Medicare provider, you may treat members of our Medicare Advantage PPO plans without a referral, even if you don’t participate in our networks. Review how to identify these members.

Use Updated Medicare Outpatient Observation Notice

The Centers for Medicare & Medicaid Services updated the notice that hospitals and critical access hospitals are required to give Medicare Advantage plan members who are under outpatient observation for more than 24 hours. Learn how to access the notice.

Encourage Medicare Members To Respond to Health Outcomes Survey

The Centers for Medicare & Medicaid Services surveys a sample of our members to rate their care. Learn about survey topics our members may discuss with you.

See Tips for Helping Members Get the Care They Need

For members who need help navigating care, primary care teams can provide guidance that improves patient experiences. Review tips on helping patients access care and specialists, if needed.

Review Guideline on Benzodiazepine Tapering

The American Society of Addiction Medicine’s clinical practice guideline provides information on safely tapering patients from BZD medications while minimizing withdrawal symptoms.

Discuss Colon Health and Preventive Screening with Members

Preventive screening for colorectal cancer is recommended for adults ages 45 to 75. Review screening tests and tips to close care gaps.