PROVIDER NOVEMBER NEWS

Devoted Health named among the best MA carriers for 2026 by U.S. News & World Report

For the second year in a row, U.S. News & World Report recognized Devoted Health as one of the Best Medicare Advantage carriers in the country, earning the highest rating in three categories: Best Overall, Best for Screening & Prevention, and Best for Care Continuity for 2026.

Get ready for the new plan year!

Drug list and Part B step therapy requirements

We’ve made changes to our drug list and Part B step therapy requirements that may impact your patients. 

Review our formulary and step therapy lists

Explore new provider tools and resources

• For key contacts and information, bookmark and share our 2026 Quick Provider Reference Guide.
• See a complete list of delegated partners in the 2026 Devoted Partner Guide.
• Review our full list of plan and coverage information.

2026 Provider Manual

View the 2026 Provider Manual. Review updates and refer to our previous announcement for a summary of changes.

• Facility Responsibilities: Added guidance for complying with Notice of Medicare Non-Coverage (NOMNC) requirements.
• Paper Claims: Clarified that a transaction fee may apply for paper checks.
• Payment Disputes and Reconsiderations: Updated to clarify dispute timeframes and updated instructions for submitting payment disputes and payment integrity audit disputes. 

Verifying benefit coverage

Check member eligibility, submit referrals and prior authorizations, and manage claims through our Provider Portal. Learn how to get set up today.

Prior authorization questions? 

Use our Utilization Management Quick Reference Guide to understand our process and how we collaborate with you to ensure the best member care.

Oncology prior authorizations 

Devoted Health partners with OncoHealth for oncology services. OncoHealth is hosting training sessions on the new OneUM system — covering recent updates and new features. Sign up for a training.

Behavioral health update

Effective January 1, 2026, Devoted Health will directly administer all behavioral health benefits — no longer through Magellan Healthcare. Please use the standard eligibility and claims submission processes for dates of service beginning on or after January 1.

Payment policy updates

Stay up to date with Devoted Health's latest payment policies. These policies go into effect on January 1, 2026 and will be posted by December 1, 2025. The latest updates are listed below:

• NEW Billing and Cost-Sharing for Dual Eligible Members: Explains cost share protections for dual-eligible members.
• NEW Paper Check Transaction Fee: Establishes Devoted’s transaction fee for paper checks.
• NEW NOMNC Compliance, Documentation, and Provider Requirements in Appeals: Clarifies provider responsibilities during a member appeal, and establishes reimbursement for SNF providers only up to the coverage end date specified by a valid NOMNC.
• Ambulatory Surgical Centers (update): Clarifies billing expectations for ASCs. Facility charges should be submitted on the institutional claim (UB-04 or CMS-1450). When a 837P or CMS-1500 is used, the billing and rendering NPI types will determine whether a claim is treated as facility or professional.
• Continuous Glucose Monitors, Blood Glucometer & National Drug Codes (update): Expands preferred brands for blood glucometers and diabetic supplies and provides covered NDCs for each brand.
• Home Health Services Billing (update): As of 1/1/26, the number of home health visits allowed before requiring PA is 5. For visits beyond the 5th, providers need to submit prior authorization request.
• TIN Validation (update): Specifies that the billing name and TIN must be validated with the IRS database before they can be accepted as eligible for payment.

Diabetic supply and insulin coverage

Testing Supplies:

Beginning January 1, 2026, Devoted Health plans will no longer cover OneTouch® glucose meters and supplies. Accu-Chek® Smartview and Guide Me glucose meters, strips, and supplies will remain covered in 2026. 

Basal Insulin:

Starting January 1, 2026, Basaglar® and Tresiba® insulin will no longer be covered. Lantus® (vial and Solostar pen) and Toujeo® (Solostar and Solostar Max pen) will be the preferred basal insulins in 2026. 

Verifying C-SNP patients

The Centers for Medicare & Medicaid Services (CMS) requires confirmation from a treating provider that newly enrolled C-SNP members have at least one qualifying chronic condition within 60 days of enrollment. You can verify by:

1. 1.  Faxing the completed verification form to 1-833-434-0535.
2. 2.  Calling 1-877-762-3515 to verify the member’s condition by phone (Monday–Friday, 8am to 5pm local time).
3. 3.  Uploading the form through the Devoted Provider Portal (for participating PCP groups) See our step-by-step guide.

Learn more about our SNP plans

Florida D-SNP amendment

Devoted’s Florida D-SNP Regulatory attachment has been updated. Visit our Policies and Compliance page to review the full Attachment. 

Closing Stars gaps and a new HEDIS reminder

Help close care gaps using your Stars Actionable Gap Report and submit any outstanding data through the Provider Portal, uploading to a SFTP, sending a fax to 877-420-4662, or emailing stars@devoted.com. The deadline for data submission is February 28, 2026. 

HEDIS Medical Record Review (MRR) begins February 2026.

You may hear from Datavant (formerly CIOX) to make this process as easy as possible. During MRR, 411 members are selected for each hybrid measure in each contract, which determines our final rates.

 Risk adjustments documentation reminder and tools

Patient risk scores reset each year on January 1. To ensure complete and accurate documentation:

• Reassess and document all active and chronic conditions each year. 
• Mark inactive or resolved conditions appropriately.
• Document conditions at any face-to-face visit, including Annual Wellness or Comprehensive Physical Exams — both covered each calendar year. Devoted will also continue covering telehealth visits in 2026.
• Include up to 12 diagnosis codes per claim; use CPT code 99499 for additional codes. Visit the Availity resources section to access our Documentation Tip Sheets on submitting 13+ diagnosis codes.
  
  Email RAF@devoted.com with any questions or thoughts.

Special Investigations Unit update

The 2026 CPT code set introduces over 400 updates, including new codes for remote monitoring and AI-assisted services. These codes require specific time and context to be billable.

• Remote Monitoring: New codes for shorter monitoring periods and reduced time thresholds. 
  • Medical records must clearly show that the patient submitted data for the minimum number of days and include verifiable time logs for the physician/QHP management services. 
• Augmented AI Services: New codes formalize the use of Artificial Intelligence (AI) to assist with services like imaging and cardiac risk analysis.
  • When using an AI-assisted code, your documentation must explicitly state the role of the AI software and describe how you used the AI’s findings to reach your final Medical Decision Making (MDM).

Please review AMA and CMS guidance to ensure compliant and timely billing.

Directory Data Attestation
Download the PAR report from the Devoted provider portal to review in-network provider information. Email a roster to provider-updates@devoted.com to update the following information in provider directories:

• Ability to accept new patients
• Street address
• Phone number
• Any other changes that affect availability to patients

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