Fee Schedules Effective Jan. 1, 2026, are now available online for all commercial plans (login required).

Each year, we review and update our commercial fee schedules. We evaluate national and regional data to develop fee schedules that balance the needs of providers with those of employers and members, ensuring we’re providing excellent and affordable health care to the communities we serve.

EVV Required for Select Home Care Medicaid Services Beginning January 1

Beginning Jan. 1, 2026, the Michigan Department of Health and Human Services (MDHHS) will require Medicaid claims containing select home health care service (HHCS) codes to be submitted using Electronic Visit Verification (EVV). This requirement applies to all applicable claims submitted with a date of service on or after Sept. 3, 2024. 

What do you need to do?

• Use HHAeXchange (HHAX) for EVV claims processing 

• Complete onboarding with HHAX and begin submitting claims using EVV as soon as possible to avoid claim denials or delays

Why HHAX?

MDHHS selected HHAX as the official EVV system for home health care services under Medicaid to prevent fraud, improve care quality and meet the federal 21st Century Cures Act mandate. Providers must use this system to comply with federal and state EVV requirements.

Where to find more information

• EVV-required HHCS codes are listed on the Home Health Billing & Reimbursement page under:
  Billing & Reimbursement → Provider Specific Information → Home Health
• Bulletin MMP 24-21 provides full details. 

• MDHHS will mail a letter to impacted providers with additional information. 
• Visit HHAX’s website for more resources.

2026 Final PIP Manual - Now Available

We sincerely appreciate the questions and feedback we received from ACNs following the release of the two Preliminary 2026 PCP Incentive Program (PIP) Manual versions. The final 2026 PIP Manual (login required) is now available. 

Following NCQA guidelines

Our PIP program’s measure targets follow NCQA guidelines. This includes targets for the Childhood Immunizations: Combo 3 (CIS-E) and Immunizations for Adolescents: Combo 2 (IMA-E) measures.

Payers and providers are facing unique challenges with vaccine hesitancy that will continue to require open conversation and creative solutions. We appreciate the engagement and innovative thinking we’ve already seen on this topic, and we’ll continue to evaluate our approach to the CIS-E and IMA-E measures as any future recommendations are made by NCQA.

Reporting update

Reporting will continue to be delivered through Filemart in 2026. We continue to work towards improved reporting in the future and will keep you updated as this work progresses.

Commercial Coverage Changes Coming for Revlimid^®

Effective Feb. 1, 2026, Revlimid will be removed from pharmacy benefit coverage for our commercial group and individual members and from our SaveOnSP drug list for members who participate in this program.

Revlimid’s generic, lenalidomide, is covered for our commercial group and individual members at Tier 4.

How will this impact members? 

• Current authorizations for Revlimid will be automatically transferred to lenalidomide for the duration of the member’s approval. 
• Those enrolled in SaveOnSP will no longer receive Revlimid at a $0 cost share.
• This change impacts 35 of our members. 

What does it treat?

Both Revlimid and lenalidomide are used to treat certain types of blood cancer. 

2026 Scheduled Maintenance Dates for TurningPoint's Autorizations Portal

TurningPoint’s authorizations portal is intermittently offline for scheduled maintenance one evening per month, from 7 p.m. on a Saturday to 12 a.m. the following Sunday (Eastern Time).  

2026 scheduled maintenance dates include: 

• Jan. 10, 2026
• Feb. 7, 2026
• Mar. 7, 2026
• Apr. 11, 2026
• May 9, 2026
• June 6, 2026
• July 11, 2026
• Aug. 8, 2026
• Sept. 12, 2026
• Oct. 10, 2026
• Nov. 7. 2026
• Dec. 12, 2026

On these dates, the TurningPoint authorizations portal will be unavailable to submit authorization requests for 5–10-minute intervals between 7 p.m. to 12 a.m. 

You may wait to submit your authorization requests until the portal is back online, or you may choose to submit via phone or fax. 

• Phone: Call 313.221.5553 or 855.511.0840 (toll free)

• Fax: Submit TurningPoint’s authorization intake form to 313.261.7199 or 833.374.0036 (toll free)