PROVIDER PORTAL: NEWS AND TIPS
NEW! Upload rosters in the Provider Portal
You can now submit roster updates through the Devoted Provider Portal! Just log in to the provider portal using your Availity credentials and select Provider Data Upload from the homepage. From there, select the type of update you want to make and upload your file. For more information, see our provider data and credentialing page.
Knowing when to submit a prior authorization
We want to make the prior authorization (PA) process as simple and efficient as possible so you can enhance the quality of care for your patients. You can quickly confirm if a service requires PA with just a few clicks in the Provider Portal to save valuable time. If a service isn’t on our prior authorization list, then you do not need to submit a prior authorization request. Below are some frequently asked questions to help you navigate PA submissions.
When do I need to submit a PA request?
Before submitting a prior authorization request, check to see if the service or medication requires prior authorization using the “Authorization Check” tool in your Devoted Health Portal or refer to our prior authorization page for a full list of requirements. If the service/medication is not listed, you do not need to submit a request for prior authorization.
If you have questions or can’t find a service/medication on the above lists, you can always reach out to our Provider Services team for assistance.
What’s the fastest way to submit a PA?
For the fastest turnaround, please submit requests through the Devoted Provider Portal using your Availity login.
- 1. Log in to the Devoted Provider Portal using your Availity credentials. If you are new to Availity, register now to get started or learn how to access our portal with your Availity credentials.
- 2. Select New Authorization/Referral.
- 3. Fill in the required fields to complete your request.
- 4. If the service or medication does not require prior authorization, a red pop-up will appear.
How do I submit a PA request via the portal?
For a refresher on how to submit a prior authorization, check out this step-by-step guide or video tutorial.
Download our UM Quick Reference Guide
Medicaid ROPA enrollment
Our partnership with you is vital to providing high-quality care to our most vulnerable members — those dually eligible for both Medicare and Medicaid. To ensure seamless claims processing, we want to clarify a critical requirement regarding your enrollment status with your state Medicaid agency.
Providers who order, refer, prescribe, or attend to Medicaid beneficiaries must be enrolled in the state Medicaid program.
Why this matters to your practice
Even if you do not intend to bill Medicaid directly for services, you must be enrolled in the State Medicaid program on at least a ROPA (Ordering, Referring, Prescribing, or Attending) basis if you treat members who:
- • Are enrolled in a Medicare Advantage Special Needs Plan (SNP).
- • Receive secondary coverage through Medicaid Fee-For-Service (FFS) or a Medicaid Managed Care Organization (MCO).
The consequences of non-enrollment
Failure to maintain an active Medicaid ID (even for ROPA-only purposes) results in:
- • Claim Denials: Automated systems will reject "crossover" claims where the performing or referring NPI is not recognized by the state.
- • Pharmacy Disruptions: Prescriptions written by non-enrolled providers may be denied at the pharmacy for Medicaid members.
- • Compliance Risk: Our network is required to ensure that all providers seeing dual-eligible members meet state and federal credentialing standards.
How to comply
The ROPA enrollment process is a streamlined version of full Medicaid enrollment. It does not require you to see Medicaid-only patients or accept Medicaid's fee schedule for all your patients; it simply validates your credentials within the state system. Please visit your state Medicaid website for additional details — see links to each state Medicaid website on our website here.
We value the care you provide to our members. By completing this enrollment, you protect your practice from administrative burden and ensure our members receive their benefits without interruption.
Payment policy updates
We’ve introduced new payment policies to support accurate billing and streamlined claims processing across the network.
For the most current versions of all payment policies, including recent updates, please visit our website regularly to ensure you’re referencing the latest guidance.
Final rule changes for MY2026
In April 2026, CMS released the Final Rule that highlights key changes for Stars measure year 2026 "MY2026." They are as follows:
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Statin Therapy for Patients With Cardiovascular Disease (SPC) is no longer an official Stars measure for MY2026. CMS has moved this measure to the Display Page for two years (MY2026 and MY2027). SPC has been removed from the Stars Report Cards on the Provider Portal and Stars Actionable Gap Reports.
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Statin Use in Persons with Diabetes (SUPD) added a denominator exception for members with diabetes who do not have a statin claim but do have a paid claim for a PCSK9 inhibitor or bempedoic acid.
Health outcomes survey administration:
CMS will be administering the Health Outcomes Survey (HOS) to a random sample of MA members from July to November. The survey is intended to assess members' physical and mental health over time and their ability to carry out everyday activities (physical activity, bladder control issues, fall risk). The HOS is part of Star Ratings and is an integral piece to evaluate the effectiveness of Devoted Health’s overall quality and health of our members.
You can support this by reviewing our Overview and Best Practices resource, which covers topics like discussing physical activity with patients, strategies to stay active, fall prevention and balance concerns, mental health awareness, and bladder control issues.
Upcoming RADV audits:
CMS has updated the timelines for PY20–PY24 RADV audits, and Devoted anticipates being selected for these audits. We may reach out to your office to request medical records that support reported diagnoses included in in the audit sample. To help manage this high volume of requests efficiently, many providers have asked us to set up EHR access to directly pull the needed records. Please email any specific retrieval workflows or contact preferences to radv@devoted.com.
Documentation tips for cancer:
To accurately report cancer as active, the patient should have an active presence of cancer at the visit or be undergoing active treatment. Active cancer should be documented according to the below tips.
