Provider News and Updates

A Message to Our Valued Provider Partners

We recognize that recent news may have created uncertainty, and we want to provide clear reassurance: Providence Health Plan remains fully operational, and there are no changes to coverage or services for members at this time. Members continue to rely on you for their care, and uninterrupted access remains our highest priority. Learn more.

Keep Your Directory Information Up to Date

Accurate directory information helps patients find your practice. When you receive the quarterly verification spreadsheet, review both the Provider and Clinic tabs, and update as needed. Thank you for helping us keep this information current.

DME Network Vendor Change Effective June 1

Effective June 1, 2026, Providence Health Plan transitioned its DME network to Integra. Integra is a national DME provider with a broad network of suppliers, giving Providence Health Plan members more flexibility and access. Learn more.

To support appropriate utilization and accurate reimbursement, several payer-driven policy updates have been or will soon be implemented. See below for a key update that may impact workflows and documentation.

See all new policies.

Optum EDC Analyzer

Effective July 1 – Commercial and Medicare

The Optum EDC Analyzer will evaluate emergency department facility claims based on documented service intensity and patient complexity. Claims that do not support the billed level of care may be adjusted or denied. Learn more.

Health Outcomes Survey Season is Approaching

The 2026 Medicare Health Outcomes Survey (HOS) will be conducted from July 13–November 2. This survey not only measures how well patients maintain or improve their health over time, it also directly impacts Medicare Star Ratings which can influence reputation and value-based reimbursement opportunities. Learn more.

Behavioral Health Onboarding Webinar

Join our Behavioral Health Network team for a brief onboarding session covering:

• ProvLink navigation
• Policy updates
• New provider onboarding essentials

July 23 at 12 p.m.

Spotlighting the programs and services designed to support our members—and, in turn, the providers who care for them.

Patient Resources to Support Mental Health and Life Balance

Providence Health Plan coverage offers access to a wide range of behavioral health and wellness resources—including convenient virtual options—for stress management, work-life balance, and complex mental health needs.

You can extend support beyond the visit and help improve outcomes of patients who could benefit when you connect them to these resources. Download the flyer in English or Spanish. The flyer outlines available resources and how your patient can access.

Direct links to frequently accessed resources:

Notices

Policies & Information

Prior Authorization Form

Provider Hub

Provider Training

ProvLink

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