Medicare AdvantagePrior AuthHigh impact
Q3 2026 newsletter
Devoted Health·AL, MS, PA · Sleep Medicine, Oral & Maxillofacial Surgery, Orthopedics +1 more·Provider News
Effective date
Sep 1, 2026
We identified it
Sep 24, 2026
Summary
Devoted Health is implementing multiple operational and clinical changes effective September 1, 2026, including: (1) switching payment platforms from Payspan to Zelis ePayment Center, (2) removing prior authorization requirements for 5 sleep-study codes and 15 TMJ-related codes, (3) expanding claims-based PCP assignment policy to include mid-level providers and PPO members, and (4) launching new dispute determination letter viewing in the provider portal. Additionally, home health/DME services in AL, MS, and PA are transitioning to Integrated Home Care Services management.
Action Required
By September 1, 2026: (1) BILLING TEAM: Enroll in Zelis ePayment Center or contact 855-774-4392 to ensure uninterrupted electronic payment and remittance advice delivery. Update payment processing workflow documentation. (2) BILLING TEAM & PROVIDERS: Remove prior authorization requirements from billing system for CPT codes 95805, 95807, 95808, 95810, 95811 (sleep studies) and 21010, 21050, 21060, 21073, 21085, 21240, 21242, 21243, 21299, 21480, 21485, 21490, 21497, 29800, 29804 (TMJ procedures). Update encounter forms to reflect PA removal. (3) PROVIDERS IN AL, MS, PA: Coordinate with Integrated Home Care Services (IHCS) for prior authorization, coordination, and delivery of DME, Home Health, and Home Infusion services; provider network remains unchanged. (4) ALL STAFF: Familiarize with new Devoted Provider Portal dispute determination letter viewing feature (access via Availity Payer Spaces > Claims Tools > search by Claim/Dispute ID). (5) FRONT DESK & CLINICAL STAFF: Begin discussions with patients about flu vaccine eligibility (September 1-December 31) to earn Devoted Dollars and improve CAHPS survey performance for March 2027. (6) PROVIDERS SERVING SNP MEMBERS: Ensure all staff complete 2026 Model of Care training before September 1. Failure to implement may result in claim denials for affected codes, payment processing delays, and loss of care coordination efficiency.