Part B drug step therapy requirements updates
Some Part B medications require step therapy under the plan’s coverage policies. Because criteria may change, please review the most current requirements before submitting a request. This helps reduce delays and prevents follow-up requests for additional clinical information.
See our drug coverage limits
Prior authorization for complex cataract surgery
Prior authorization requirements for complex cataract surgery have been removed, effective February 16, 2026.
Prior authorization for oncology reviews
Oncology authorization requests must be submitted to OncoHealth. Please submit all oncology authorization requests directly to OncoHealth through the following channels:
OncoHealth platform (faster and preferred)
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In Availity, go to Devoted Health’s payer space and select Oncology Authorization Request under the Applications tab on the home screen, or
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Go to Devoted Health’s payer space, and select Oncology Authorization Requests.
- If OncoHealth access credentials are needed for the portal, contact the client support team at 888-916-2616 or send an email to clientsupport@oncohealth.us
Fax
Fax it to 800-264-6128. (This may result in delays due to manual processing.)
NEW risk adjustment updates: diagnosis deletions
To delete an incorrect or unsupported diagnosis for risk adjustment, please submit it using the Risk Adjustment Supplemental Data Flat File.
Devoted Health accepts risk adjustment provider supplemental files for diagnoses with claims, correct submission errors, supplement claims with internally identified codes, capture historical diagnoses for new members, and delete previously submitted codes.
Need help getting started? Email: risk_supplemental_file@devoted.com to request the Risk Adjustment Provider Supplemental File Job Aid.
You can also visit the Devoted’s payer space in Availity for documentation tip sheets, printable clinical gap forms, and primary care provider (PCP) visit reporting (including gap counts). For clinical documentation feedback or questions, email RAF@devoted.com.
Payment policy updates
New Acute Hospital Care at Home Claims Processing is now available to view. This guide provides billing and payment guidance for inpatient-equivalent home services under the H@H model (Revenue Code 0161 and/or Occurrence Span Code 82).
See the Acute Hospital Care at Home Claims Processing
Get our latest payment policies
Medicare insulin prescriptions and diabetic supply coverage
To help avoid pharmacy delays and callbacks, Medicare requires short-acting insulin vial prescriptions to clearly state how insulin will be administered (for example, via a durable medical equipment (DME) pump or another method). Please include the following on every insulin prescription:
- Method of administration (pump, patch/pod, wearable device, or self-injection)
- Units per dose
- Timing/frequency
When appropriate, please consider prescribing insulin pens.
2026 covered insulin and glucose testing supplies
Devoted Health has updated coverage for several diabetic products, including
- Short-acting insulin, including Novolog (insulin aspart), Admelog (insulin lispro), Fiasp (insulin aspart), Novolin R (regular insulin), and Humulin R (regular insulin). Each is available in pen and vial form.
- Intermediate-acting insulin including Novolin N, Novolin 70/30 mix, and Novolog Mix 70/30.
- Long-acting insulin including Lantus (insulin glargine) and Toujeo (insulin glargine).
- Fingerstick glucose testing supplies include Accu-Chek Guide glucose meters, strips, control solution, and Softclix or Fastclix lancets.
- Continuous glucose monitor (CGM) devices include Freestyle Libre and Dexcom G6 and G7 series.
Q1 Stars and quality updates
Healthcare Effectiveness Data and Information Set (HEDIS) medical record review request
The HEDIS medical record review (MRR) season is underway! You may hear from our partners at Datavant or directly from your market partners requesting medical records for measure year 2025. We chose Datavant as our partner for medical record retrieval because we know some providers may already work with them via other plans. Our aim is to cause as little burden as possible. We greatly appreciate any supplemental data you may have already given us to help close gaps for Star Rating measures and any additional data you can give us to help close out the year!
Consumer Assessment of Healthcare Providers and Systems (CAHPS) update
The Centers for Medicare & Medicaid Services (CMS) survey period started on February 25 and runs through the end of May. Selected members will receive the survey by email or mail in early March. We appreciate all you do year-round to support CAHPS performance by ensuring that members get the care they need, and in this critical period, we ask that you please:
Devoted continues to support performance with outreach programs to members to support navigating benefits and accessing care. We have notified members of the upcoming survey and encouraged their participation.
Special Needs Plan (SNP) Model of Care (MOC) training reminder
CMS requires all contracted providers who serve our SNP members to complete the MOC training every year. Please review our 2026 Model of Care and ensure that all applicable providers and staff complete the training. No attestation is required.
Have questions about our SNP plans?
Check out our SNPs Resources for Providers
