What types of insurance policy changes does this tracker cover?

We track billing and reimbursement policy changes from major U.S. health insurance payers including Cigna, UnitedHealthcare, Aetna, Humana, and regional carriers. Changes include prior authorization updates, coverage determinations, CPT/HCPCS code additions and deletions, fee schedule revisions, and plan-type policy modifications.

How often are new policy changes added?

Our scraper runs daily, so most policy changes appear within 24 hours of the payer publishing them. Each entry shows the date we first identified the change alongside any stated effective date.

Can I filter changes by my specialty or state?

Yes. Use the provider hub, specialty hub, state hub, or billing code hub to narrow the feed to changes that affect your practice. You can also create a free saved search to get email alerts for exactly your filters: daily or weekly, your choice, on every plan.

Are historical policy changes available?

Yes. Use the per-year archive links to browse changes by calendar year, or use the pagination below to scroll back through all tracked changes in chronological order.

PAYER POLICY CHANGES

All Insurance Policy Changes

Daily-updated index of every insurance policy change we track, across all payers, specialties, states, and plan types. Each entry is AI-summarized and tagged with impact level so you can triage at a glance. New entries are added daily as payers publish updates.

Medi-Cal · Effective Jan 1, 2027High impact
FQHC and RHC Policy for UIS Members Transitioning to Fee-for-Service on January 1, 2027
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status move from Medi-Cal managed care plans to Medi-Cal fee-for-service, so FQHC and RHC claims for these members must go directly to the Medi-Cal fiscal intermediary rather than to the former plan. Effective for services on or after January 1, 2027, claims sent to the former plan or to the FI for an MCP differential (wrap) rate will be denied, and from July 1, 2027, emergency and pregnancy-related services for these members are reimbursed only at the PPS rate with the appropriate diagnosis code and emergency indicator.
Medi-Cal · Effective Jan 1, 2027Medium impact
Medi-Cal Fee-for-Service Provider Toolkit for UIS Transition is Available
Medi-Cal published a provider toolkit to help providers prepare for the federal requirements starting January 1, 2027, under which Medi-Cal members with Unsatisfactory Immigration Status (UIS) who receive care through Medi-Cal fee-for-service will transition out of managed care. The toolkit covers accepting new patients, enrolling in Medi-Cal fee-for-service, verifying eligibility, TAR continuity, transportation services, and services available in both managed care and fee-for-service, and is posted on the Ordering, Referring and Prescribing and Medi-Cal Managed Care to Fee-for-Service Transition web pages.
Medi-Cal · Effective Jul 1, 2026Medium impact
Fee Schedule Rate Update for 2026 Codes
Medi-Cal updated payment rates for selected procedure codes, effective for dates of service on or after July 1, 2026, with the updated rates posted on the Medi-Cal Rates page under Adjusted State Plan Amendment Rates. Medi-Cal will run an Erroneous Payment Correction to reprocess claims at the new rates for dates of service on or after the billing policy's effective date, including claims submitted under earlier guidance that were paid at prior rates.
BCBS Oklahoma · Identified Nov 7, 2026Low impact
Verify Your Directory Information Every 90 Days
Blue Cross and Blue Shield of Oklahoma published a November 6, 2026 notice that federal law requires provider directory information (name, address, phone, specialty, digital contact information) to be verified every 90 days, even without changes. Practices can verify through the Qualified Health Plans directory, Availity Essentials Provider Data Management, or the Demographic Change Form, and must update changes with the payer, the CAQH Provider Data Portal, and the NPPES NPI Registry.
Cigna · Identified Nov 7, 2026Low impact
Cigna Healthcare introduces Health Sense® to connect health guidance, benefits and support
Published October 6, 2026: Cigna Healthcare announced Health Sense, a connected patient experience and clinical support model built on existing myCigna, customer service, care management and clinical support services. Cigna says it will begin rolling out Health Sense in the first quarter of 2027, initially supporting oncology and cardiometabolic health needs, and that it does not diagnose, prescribe, modify treatment or replace the treating provider. The content does not describe any new billing, coding, prior authorization or claims requirement for practices.
Cigna · Effective Oct 31, 2026High impact
Summary of Provider Newsroom U.S. commercial medical articles
Cigna Healthcare's October 2026 Provider Newsroom recap lists several U.S. commercial items, most notably a prior authorization portal change: effective October 31, 2026, EviCore by Evernorth will move prior authorization requests for certain Cigna Healthcare services from the MedSolutions portal to the CareCore portal on EviCore.com. Other items cover drug list updates for Cigna Specialty Care Options and Cigna Pathwell Specialty, a Specialty Medical Injectables reimbursement restriction requiring dispensing and claim submission through a Cigna-contracted specialty pharmacy, and a 270/271 eligibility transaction enhancement.
Cigna · Identified Nov 7, 2026Low impact
Summary of Provider Newsroom behavioral health articles
Evernorth published a monthly recap of its October 2026 behavioral health Provider Newsroom articles, covering continuity and coordination of care between medical and behavioral health providers, completion of the third and final phase of CAQH CORE recertification enhancements to the 270/271 eligibility and benefits transaction (applying to medical, dental, and behavioral health providers, dated October 5, 2026), and California and New Mexico language assistance program requirements. Billing teams should note the completed 270/271 enhancement for eligibility verification workflows and review the linked articles for any operational steps.
Ambetter · Identified Nov 7, 2026Medium impact
Reminder: Use Paid-through Dates to Verify Member Eligibility
Published May 2026: Ambetter Health reminded providers to verify member eligibility by checking the eligibility status, premium paid-through date and claims paid-through date before or near the date of service, because Marketplace members who miss premium payments enter a grace period (generally 90 days for subsidized members) and coverage may be retroactively terminated, which can lead to previously paid claims being denied. Billing staff should confirm each member's status in the Centene provider portal or Availity and interpret the status reasons (Active, Active – Pending Investigation, Delinquent, Suspended, Inactive) before billing.
Ambetter · Effective Jan 1, 2027Medium impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Published June 22, 2026: Ambetter Health announced that 46 listed HCPCS H codes will no longer be covered beginning January 1, 2027, while HCPCS H0006 will become covered on that same date. Billing teams should identify claims and scheduled services using the listed H codes for January 2027 dates of service and prepare charge entry and provider notification accordingly.
Ambetter · Effective Dec 6, 2026High impact
Leveling for Facility Claims
Ambetter from WellCare of Kentucky will apply national CPT guidelines to the coding of outpatient emergency department E&M levels for facility claims beginning 12/06/2026. Under the payer's comparative peer risk adjustment process, E&M claim lines will be recoded to the corrected level, with reimbursement at the highest level whose criteria are met, based on facility resources such as nursing time, clinical staff effort, supplies, equipment, and overhead rather than provider cognitive work. The payer's policy CC.PP.80 replaces the previous Optum EDC Analyzer.
Ambetter · Identified Nov 7, 2026Medium impact
Enhancing the Claims Experience in Availity Essentials
Beginning in December 2026, providers using Availity Essentials will be able to submit claim disputes/reconsiderations and appeals in the portal, download determination letters and notices, and access previously submitted attachments. Attachment capacity per request expands to 600 MB total, with up to 10 files per request at 60 MB per file. Access to these tools requires the Claim Status role, and Availity is offering free live training sessions on December 8 and December 10, 2026.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Healthier Oregon Transition Data Guidance for Prior Authorizations
Oregon's Office of Health Policy (OHA) directed coordinated care organizations (CCOs) to submit prior authorization data for Healthier Oregon members transitioning to the Oregon Health Plan Open Card program, covering approved prior authorizations for prescription, medical, behavioral and oral health services to be rendered on or after Jan. 1, 2027, plus program exception approvals. Practices in Oregon that serve these members should expect prior authorizations to be entered into fee-for-service claims processing on the dates listed, so billing staff should confirm which active authorizations carry 2027 effective dates and that claims reference them correctly.
Horizon BCBS NJ · Identified Nov 7, 2026Low impact
Mailing Address Update: BlueCard® Claims, Appeals, Medical Records
Published June 2024: Horizon BCBSNJ created a new mailing address, Horizon BCBSNJ BlueCard Claims, Three Penn Plaza East, Suite 1, Newark, NJ 07105-2248, for BlueCard claims, appeals and medical records from practices and facilities. Billing teams should send these items to the new address rather than the previous BlueCard PO Box 1301, and the USPS will forward mail sent to PO Box 1301 through the end of 2026.
Geisinger Health Plan · Effective Jan 1, 2027Medium impact
Preparing for new interoperability enhancements coming in 2027
Geisinger Health Plan (GHP) announced it will implement CMS-0057-F interoperability requirements, including a Provider Access API for in-network providers and a Prior Authorization API for electronic prior authorization exchange, with compliance beginning January 1, 2027 for Geisinger Gold (Medicare Advantage and Medicaid managed care), GHP Family, GHP Kids, Geisinger Marketplace, and FEHB products. Providers and their technology partners will need to register through the GHP Developer Portal and confirm a treatment relationship before member data can be requested; the publication says prior authorization requirements and decision criteria are unchanged.
SC Medicaid - SCDHHS · Effective Dec 15, 2026Medium impact
Updated Prior Authorization Expansion on Physician-administered Drugs
South Carolina Medicaid will require prior authorization for a list of physician-administered drugs when given to fee-for-service Healthy Connections Medicaid members. The drug list is published in the procedure codes section of the Physicians Services Provider Manual and is updated with the added drugs beginning December 15, 2026.
Humana · Identified Nov 7, 2026Medium impact
Quviviq (daridorexant) (Revised)
Humana published a revised Medicare step therapy policy for Quviviq (daridorexant) tablets for insomnia, with a revision date of October 28, 2026. Members must have previously tried, been contraindicated to, or been intolerant of Belsomra (suvorexant) or trazodone tablets before Quviviq is covered, and Quviviq is contraindicated in patients with narcolepsy. The policy was originally effective January 1, 2024.
BCBS Illinois · Identified Nov 7, 2026Medium impact
Verify Your Directory Information Every 90 Days
Blue Cross Blue Shield of Illinois requires contracted providers' directory information to be verified at least every 90 days, even when nothing has changed, citing Illinois House Bill 5395 and the federal Consolidated Appropriations Act of 2021. Commercial provider groups should request or submit rosters every 90 days, facilities and ancillary providers should use the Demographic Change Form, and HMO medical groups and IPAs continue monthly roster submission.
Kaiser Permanente · Identified Nov 7, 2026Low impact
November 6, 2026 Kaiser Permanente and Risant Health Q3 2026 financial update Kaiser Permanente and Risant Health continued to provide high-quality, …
Kaiser Permanente and Risant Health published their Q3 2026 financial update on November 6, 2026, reporting on financial results and continued high-quality care. The item is a corporate financial announcement and does not describe any change to coverage, prior authorization, billing codes, or claims requirements for providers.
L.A. Care Health Plan · Effective Oct 28, 2026High impact
Updated HCPCS Codes Requiring Prior Authorization – Medicare
L.A. Care Health Plan now requires prior authorization for eight HCPCS codes for its Medicare members, following CMS's addition of those codes to the DMEPOS Required Prior Authorization List, effective October 28, 2026. Separately, 22 HCPCS codes were added to the Required Face-to-Face Encounter and Written Order Prior to Delivery list effective the same date, requiring a documented face-to-face encounter within six months before the written order and communication of the order to the supplier before delivery.
BCBS Texas · Identified Nov 7, 2026Low impact
Verify Your Directory Information Every 90 Days
Blue Cross and Blue Shield of Texas published a reminder that provider directory information must be verified every 90 days, even if nothing has changed, and that changes to name, address, phone, specialty, or digital contact details must be updated with the payer, the CAQH Provider Data Portal, and the NPI Registry. Practices can verify through Availity Essentials Provider Data Management or the Demographic Change Form, and Texas Medicaid providers must update through PEMS.
Ohio Medicaid · Effective Nov 2, 2026Medium impact
5160-1-05.3 - Payment for "Medicare Part B" cost sharing. (Amend/Revise)
Ohio Department of Medicaid filed a revised version (Amendment, effective 11/02/2026 per the filing record) of rule 5160-1-05.3, which governs payment for Medicare Part B cost sharing. The filing record shows the revision was filed 11/06/2026; the excerpt does not provide the substantive payment text, so the specific changes to cost-sharing payment cannot be identified from it.
Aetna · Identified Nov 7, 2026Medium impact
In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-27)
Aetna's Clinical Policy Bulletin 0783 (reviewed 2026-10-27) confirms that in vivo analysis technologies for gastrointestinal and urothelial lesions, including confocal laser endomicroscopy, narrow-band imaging, chromoendoscopy and optical biopsy systems, are considered experimental, investigational or unproven for the listed indications. Claims for these services with the listed CPT codes (such as 43206, 43252 and +0397T) and ICD-10 diagnoses will be denied under this policy, so billing staff should review how these services are coded and documented before submission.
UnitedHealthcare · Effective Nov 1, 2026Medium impact
Vitamin D Testing
UnitedHealthcare's Medicare Advantage Vitamin D Testing medical policy, in the November 2026 bulletin effective 2026-11-01, removed ICD-10 diagnosis codes C88.4, Z79.60, Z79.61, Z79.620 through Z79.624, Z79.630 through Z79.634, Z79.64, and Z79.69 from the applicable codes list, and updated the CMS related documents list and clinical evidence references. Billing teams should stop relying on the removed diagnosis codes when submitting Vitamin D testing claims for Medicare Advantage members and confirm that remaining claims carry a supported diagnosis.
UnitedHealthcare · Effective Nov 1, 2026Low impact
Uterine Services Procedures
UnitedHealthcare's Medicare Advantage medical policy bulletin for November 2026 revised the Uterine Services Procedures coverage rationale. The coverage language on MRI-guided focused ultrasound ablation now states that Medicare does not have a National Coverage Determination for that procedure, replacing the prior reference to MRI-guided cryoablation. Billing teams should update any reference materials or coverage notes for uterine ablation services billed to these Medicare Advantage plans.
UnitedHealthcare · Effective Nov 1, 2026Medium impact
Tier 2 Molecular Pathology Procedures
UnitedHealthcare's November 2026 Medicare Advantage medical policy update for Tier 2 Molecular Pathology Procedures changes the applicable codes and removes diagnosis code Z59.7 from the non-covered diagnosis list. Billing teams should review claims for these molecular pathology procedures against the updated applicable codes and diagnosis edits.

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FQHC and RHC Policy for UIS Members Transitioning to Fee-for-Service on January 1, 2027

Medi-Cal Fee-for-Service Provider Toolkit for UIS Transition is Available

Fee Schedule Rate Update for 2026 Codes

Verify Your Directory Information Every 90 Days

Cigna Healthcare introduces Health Sense® to connect health guidance, benefits and support

Summary of Provider Newsroom U.S. commercial medical articles

Summary of Provider Newsroom behavioral health articles

Reminder: Use Paid-through Dates to Verify Member Eligibility

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Leveling for Facility Claims

Enhancing the Claims Experience in Availity Essentials

Healthier Oregon Transition Data Guidance for Prior Authorizations

Mailing Address Update: BlueCard® Claims, Appeals, Medical Records

Preparing for new interoperability enhancements coming in 2027

Updated Prior Authorization Expansion on Physician-administered Drugs

Quviviq (daridorexant) (Revised)

Verify Your Directory Information Every 90 Days

November 6, 2026 Kaiser Permanente and Risant Health Q3 2026 financial update Kaiser Permanente and Risant Health continued to provide high-quality, …

Updated HCPCS Codes Requiring Prior Authorization – Medicare

Verify Your Directory Information Every 90 Days

5160-1-05.3 - Payment for "Medicare Part B" cost sharing. (Amend/Revise)

In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-27)

Vitamin D Testing

Uterine Services Procedures

Tier 2 Molecular Pathology Procedures