Texas Medicine Today

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November 02, 2026

Get Answers on Blue Cross and Blue Shield of Texas’ Downcoding Policy
TMA has since met with This summer, the payer implemented an evaluation and management downcoding policy. Blue Cross and Blue Shield of Texas to secure answers on transparency, process, and administrative burden.

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Uneven Field: Medicine Contends Payers Undermine the No Surprises Act’s Intended Balance

Four years into the law’s implementation, physicians say flaws in the No Surprises Act’s independent dispute resolution process, persistent insurer network inadequacy, and health plans’ failure to comply with payment requirements are undermining the law’s intended balance.

By Alisa Pierce

October 29, 2026

News

Superior HealthPlan Moves to New Payment Platform

Claims and non-claims payments will route through the platform Zelis, with phased rollouts in late 2026 and early 2027. The transition will begin with Superior's Medicare, Medicaid, behavioral health, and Ambetter programs. Get enrollment details.

By Alisa Pierce

October 30, 2026

News

Electronic Prior Auth Standards Roll Out for Medicare Advantage, More

Revised timelines, technological upgrades, and payer reporting requirements are being implemented for programs like Medicare Advantage and Medicaid under a final rule addressing electronic prior authorization. Some provisions are already in effect.

By Phil West

September 23, 2026

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News

October 26, 2026

Central Texas Physician Planning Upgrades Through Rural Texas Strong Grant

By Brian Davis
News

October 23, 2026

Houston Health to Host Measles Tabletop After Montgomery County Cases

By Brian Davis
News

October 28, 2026

Individual Health Insurance Enrollments Drop in Texas Following Changes to ACA Market Plans

By Phil West

Texas Medicine

From AI-driven downcoding to narrower networks, stalled No Surprises Act payments, Medicare Advantage's reshaping of the payer mix, and gold-card promises that haven't delivered, this issue traces how insurers are squeezing Texas physicians – and where TMA is pushing back.

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