Provider Newsletter Summer • 2026 CHANGE SERVICE REQUESTED PO Box 971100 El Paso, TX 79997-1100 Nonprofit Org. U.S. Postage PAID Salem, OR Permit No. 86 Help patients renew Medicaid coverage Texas Medicaid members are required to renew their coverage annually, and those requirements may be changing in the upcoming year. We at El Paso Health teach our members about these requirements and even send them reminders when their renewal dates are approaching. As a Provider, you can also help our members—your patients—maintain the coverage they need to receive their medical care. Members on Medicaid must: ■Update their information (address, phone number, income, etc.). ■Renew 2 months before their current coverage ends. ■Promptly submit any documents being requested. If you think an El Paso Health member needs assistance in submitting their renewals or has any questions about the renewals, please encourage them to call us. We offer appointments—by phone or in person—and dedicate 1-on-1 time with any member who requires help with renewals. ■STAR members can call 915-532-3778 or 1-877-532-3778. ■STAR+PLUS members can call 1-833-742-3127. If you have patients who need assistance but are not enrolled in El Paso Health, please refer them to 211 or to the Your Texas Benefits app or website. Special services for children of traveling farmworkers El Paso Health has special Medicaid services for the children of traveling farmworkers. For example, we can help schedule their upcoming Texas Health Steps exams and help them best use their vision, mental health, and transportation benefits. If you have any questions or would like more information about these services, or if you’d like us to provide an in-service training to your staff, call the Outreach Coordinator at 915-532‑3778, ext. 1075. WE GREATLY APPRECIATE YOUR COLLABORATION ON RENEWAL EDUCATION!
stay informed 2 Vaccines are in the news, on social media, and in the dinner table conversation. Measles is at the forefront, due to the rise in reported cases. People have their own views, beliefs, and concerns regarding vaccines. That is where the physician comes into play. You are the qualified professional who can best provide accurate information about vaccinations and meet your patients’ medical needs. Texas Health Steps requires an immunization record review at every visit. Are they up-to-date? Are they missing an immunization? Are they scheduled to receive an immunization soon? Each visit to your office is an opportunity for this review. A quick conversation with parents and / or the patient can often provide answers and alleviate any doubts they may have. Distributing educational material can also provide the information that they may need. Vaccines save lives, Does your documentation support your E / M level? We know how busy your days are. Taking a moment to make sure your E / M documentation supports the level you bill can help avoid issues later. Under CPT guidelines, you may select the E / M level based on Medical Decision Making (MDM) or total time spent on the date of the encounter. MDM considers three main areas: ■Problems addressed—the number and complexity of conditions evaluated and managed. ■Data reviewed or ordered—labs, imaging, tests, or outside records. ■Risk to the patient—the risk of complications, morbidity, or mortality from management decisions. In our reviews, we often see cases where the documented MDM does not fully support the level billed. This may result in recoupment during audit review. A few simple ways to strengthen your documentation: ■Clearly describe the patient’s condition and why that level of care was needed. ■Document any labs, imaging, or outside records reviewed. ■Include key risk factors or treatment decisions, such as medication changes. ■Let your clinical thinking show so the visit level is easy to understand. If selecting the level based on time, document the total time you spent on the date of service and the work performed. Taking a moment to review your notes can go a long way in supporting accurate billing and keeping things smooth during reviews. Questions? Reach out to Provider Relations anytime. and administering them at their scheduled times is necessary for infection prevention. Not only does an immunization review ensure the safety and compliance of the member, but it may also satisfy the Childhood Immunization Status Measure for HEDIS. Several records that were reviewed for this past HEDIS season had 1 or 2 immunizations missing! When Providers review the immunization record at every visit, needed vaccines can be administered so that these children can be covered. Did you review your patient’s immunization record?
news 3 Preferred status = fewer barriers to start therapy Adalimumab biosimilars: Faster access, same standard of care What is adalimumab used for? Adalimumab is a TNF-alpha inhibitor used across multiple specialties, including: ■Rheumatology (RA, PsA, AS) ■Dermatology (plaque psoriasis, HS) ■Gastroenterology (Crohn’s, UC) ■Ophthalmology (uveitis) These conditions often require consistent long-term therapy. Are biosimilars the same as generic biologics? Biosimilars are not “generic biologics” … but they are clinically equivalent. ■Highly similar to Humira® ■Expected to have no clinically meaningful differences in: —Effectiveness —Safety —Immunogenicity FDA-labeled indications for preferred biosimilar products Humira Hadlima Hulio Simlandi Rheumatoid arthritis (RA) Plaque psoriasis Crohn’s disease Ulcerative colitis (UC) Psoriatic arthritis (PsA) Hidradenitis suppurativa (HS) Ankylosing spondylitis (AS) Juvenile idiopathic arthritis Fewer prior authorization requirements. Faster claim approval at the pharmacy. Fewer treatment delays. Smoother prescribing workflow. Earlier therapy initiation. Improved adherence / continuity. Fewer interruptions from coverage issues. Better overall treatment experience. For Providers, preferred status may mean: For patients, preferred status may mean: Several adalimumab biosimilars approved by the U.S. Food and Drug Administration (FDA) are now designated as preferred products on the Texas Medicaid Preferred Drug List. Rx Rx Non-PDLPA Covered Delays Start therapy Gaps Outcomes when nonpreferred products are prescribed Outcomes when preferred products are prescribed Adalimumab Biologics Adalimumab biosimilars offer the same clinical expectations as the reference product, while preferred formulary placement may support faster access and fewer administrative delays—helping patients start and stay on therapy.
Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 1-877-532-3778, elpasohealth.com. Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP111382605 - EPH-PR-Summer 2026 Provider Newsletter 2026 © Coffey Communications, Inc. All rights reserved. WHY THEY MATTER FOR PROVIDERS Accurate billing is essential for both compliance and financial stability. For example, your reimbursement can be affected by your adherence to National Correct Coding Initiative (NCCI) medically unlikely edits (MUE). These limits, established by the Centers for Medicare & Medicaid Services, define the maximum number of units typically allowed on a single date of service. MUE help prevent billing errors, reduce improper payments, and promote consistent coding. However, noncompliance can create financial and operational challenges. Claims billed above MUE limits may be denied or reduced. This can result in lost revenue, increased accounts receivable (A / R) days, and additional administrative work. Repeated errors can also increase staff workload, slow your revenue cycle, and elevate audit or compliance risk. While both Medicare and Medicaid use MUE limits, Medicaid programs may apply stricter or state-specific limits. That means that a service allowed under Medicare may still be denied under Medicaid, depending on state rules or program policies. To reduce denials and protect reimbursement, Providers are encouraged to verify MUE limits before billing. This can be accomplished by incorporating MUE checks into billing systems, educating staff on commonly affected codes, using modifiers only when clinically appropriate, and monitoring denial trends for recurring issues. Understanding NCCI medically unlikely edits (MUE) Bottom line: MUE compliance is more than a coding requirement. It is a key strategy for minimizing denials, reducing administrative costs, and strengthening overall revenue cycle performance. stay informed
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