All Provider News
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Important update: Referral requirements & ProAuth system implementation for US Family Health Plan.
US Family Health Plan: Effective May 1, 2025, all specialty care claims for US Family Health Plan members will require a referral in the ProAuth system to ensure standard TRICARE Prime benefit processing. Learn how this affects provider claims and referral workflows.
07/23/25
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Martin's Point policies: Where to find them.
US Family Health Plan & Generations Advantage: Martin’s Point providers must adhere to Benefit, Medical, and Payment Policies for accurate claims processing and compliance. Learn how these policies affect reimbursement and claims submission.
07/23/25
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Provider directory accuracy matters.
US Family Health Plan & Generations Advantage: CMS and TRICARE require providers to maintain accurate directory information. Learn how to update your practice and provider details using Provider DataPoint.
07/23/25
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Why Star Ratings matter and why we need your support.
Generations Advantage: Discover how the 2025 Medicare Star Ratings impact patient care and provider incentives. Learn how to help maintain high ratings and ensure continued access to quality healthcare services.
07/23/25
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2024 NCQA Health Plan Ratings for US Family Health Plan.
US Family Health Plan: Martin’s Point US Family Health Plan earned a 4-star NCQA rating for quality performance in 2024, including a 5-star rating for Patient Experience. Learn more about the measures and where to find ratings.
07/23/25
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2025 formulary updates & Rx prior authorizations.
US Family Health Plan & Generations Advantage: Access the latest 2025 formulary updates for Generations Advantage and US Family Health Plan members. Find links to formulary changes, prior authorization forms, and prescription resources.
07/23/25
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Risk adjustment coding & documentation.
Generations Advantage: Learn how to improve Medicare Advantage risk adjustment documentation and coding accuracy. Follow best practices to ensure compliance with CMS guidelines and support proper reimbursement.
07/23/25
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Clinical practice guidelines.
US Family Health Plan & Generations Advantage: Learn how to improve Medicare Advantage risk adjustment documentation and coding accuracy. Follow best practices to ensure compliance with CMS guidelines and support proper reimbursement.
07/23/25
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Medicare statin use in persons with diabetes (SUPD) quality measure.
Generations Advantage: Ensure compliance with Medicare Part D's SUPD measure. Learn how accurate documentation and exclusions help maintain quality scores.
07/23/25
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Thank you for your partnership.
US Family Health Plan & Generations Advantage: Martin’s Point CHW program provides essential preventive care education and community resources to improve member health.
07/23/25