MedicaidAdministrativeHigh impact
HMSA's Online Care (HOC)
HMSA·Psychiatry·Provider News
Effective date
May 1, 2026
We identified it
Oct 4, 2026
Summary
HMSA's Online Care platform is implementing two major changes: (1) Effective May 1, 2026, behavioral health visit lengths increase from 20 minutes to 37 minutes at the base rate, with 38-60 minute visits paid at an extension rate; (2) Effective April 1, 2026, QUEST (Medicaid) members will no longer have access to Online Care, and providers must transition to alternative telehealth platforms.
Action Required
REQUIREMENTS:
By April 1, 2026: Billing team must identify all QUEST (Medicaid) patients currently using HMSA Online Care and notify them of platform discontinuation. Providers should transition QUEST members to alternative HMSA-approved telehealth platforms or in-person services. Update billing software and patient records accordingly to prevent claim denials.
By May 1, 2026: Billing team must update billing system to reflect new base visit length of 37 minutes for behavioral health services on Online Care platform. Configure system to apply base rate reimbursement for visits 0-37 minutes and extension rate for visits 38-60 minutes. Providers should review documentation practices to ensure visit times are accurately recorded for proper reimbursement. Educate billing staff on new visit duration structure to ensure correct claims submission.