What insurance policy changes were tracked in 2024?

In 2024 we tracked 9 policy changes across major U.S. health insurance payers. Changes include prior authorization rule updates, billing-code coverage modifications, fee schedule revisions, and plan-type policy changes.

How do I find 2024 policy changes for my specialty or state?

Use the related-hub links below the list to filter by provider, state, or specialty. You can also browse the full /changes feed and use pagination to reach the 2024 date range.

PAYER POLICY CHANGES

Insurance Policy Changes in 2024

All insurance policy changes we tracked in 2024. Each entry is AI-summarized with an impact rating and linked billing codes so you can quickly assess what matters to your practice.

Presbyterian Health Plan · Identified Nov 1, 2024Medium impact
2024 November Network Connection
Presbyterian's medical record review audit requires a passing score of 85% for primary care, OB/GYN, pediatric and high-volume behavioral health providers. Providers must document the status of advance directives for members 18 and older, and for members with diabetes they must document whether neuropathy screenings and retinal eye exams were completed or addressed. For preventive medicine services, new patient codes 99381-99387 and established patient codes 99391-99397 apply, and a significant, separately identifiable problem-oriented E/M service on the same day is reported with the office or outpatient code and modifier -25.
Presbyterian Health Plan · Effective Nov 1, 2024High impact
Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on Nov. 1, 2024
Presbyterian Health Plan is updating its Medical Policy Manual and Prior Authorization Guide effective November 1, 2024, adding new procedures, modifying existing ones, and retiring three procedures (Autologous Chondrocyte Implantation, Meniscal Allograft Transplant, Thoracic Spinal Surgeries, and Unicompartmental Knee Replacement). Billing teams must verify prior authorization requirements for all affected procedures using Presbyterian's updated resources and tools.
Presbyterian Health Plan · Effective Oct 1, 2024High impact
Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on Oct. 1, 2024
Presbyterian Health Plan is updating its Medical Policy Manual and Prior Authorization Guide effective October 1, 2024, adding and modifying prior authorization requirements for 18 procedures/services including new coverage for lymphedema and lipedema surgical treatment, bariatric surgery for pediatric patients, genetic/genomic testing, and various other procedures. Billing teams must verify prior authorization requirements for all affected procedures using Presbyterian's online tools before claims submission.
Presbyterian Health Plan · Identified Sep 1, 2024Medium impact
2024 September Network Connection
Prolonged services code +99417 reports prolonged total time on the date of an outpatient E/M service, and the initial 15-minute unit may be added once the time threshold for the primary E/M code has been surpassed by 15 minutes. The 2023 CPT code set revised the prolonged services codes, including CPT code 99417. Under the No Surprises Act, all providers are required to verify their directory information with Presbyterian every 90 days, and providers must be credentialed with Presbyterian before seeing any Presbyterian members.
Presbyterian Health Plan · Effective Jul 1, 2024Medium impact
2024 July Network Connection
The New Mexico Medicaid Managed Care program becomes Turquoise Care on July 1, replacing the Centennial Care name. Presbyterian Medicaid members who stayed with Presbyterian were automatically enrolled, keep their member ID numbers, and receive new ID cards, with the same benefits continuing and some new covered services, like chiropractic, added. Presbyterian and the other MCOs are required to share authorizations and other information for Centennial Care members who enrolled in a different MCO for Turquoise Care.
Presbyterian Health Plan · Identified May 1, 2024Medium impact
2024 May Network Connection
Because of the Feb. 21 Change Healthcare cyberattack, Presbyterian is informing providers of alternative methods for submitting claims to help with timely claim payments. Providers may submit claims to an alternate clearinghouse, with separate lists for behavioral health clearinghouses (Availity, Health EC, Office Ally, Payerpath and TriZetto Provider Solutions) and physical health clearinghouses (Availity, Claim.MD and Nthrive). Claims may also be submitted to Presbyterian through FastClaim, by direct entry or with an 837 electronic claims file, at mypres.phs.org.
Presbyterian Health Plan · Effective May 1, 2024High impact
Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on May 1, 2024
Presbyterian Health Plan is updating its Medical Policy Manual and Prior Authorization Guide effective May 1, 2024, adding and/or modifying prior authorization requirements for 24 procedures and services. This includes two new commercial policies (Clinical Trials Routine Patient Care Costs and Specialized Specimen Procedures) and updates to existing policies across multiple clinical areas. Billing teams must review the detailed updates document and adjust prior authorization workflows accordingly.
Presbyterian Health Plan · Effective Jan 1, 2024Medium impact
2024 March Network Connection
Effective Jan. 1, 2024, Presbyterian is no longer participating in the Hospice Value-Based Insurance Design (VBID) program. Three Presbyterian Medicare Advantage plans participated in Hospice VBID: Presbyterian Senior Care Plan 1 (HMO), Presbyterian Senior Care Plan 2 with Rx (HMO) and Presbyterian Senior Care Plan 3 with Rx (HMO). Presbyterian will continue to process claims, including hospice claims, for patients who elected Hospice VBID on or before Dec. 31, 2023 and are still on hospice.
Presbyterian Health Plan · Effective Jan 1, 2024Medium impact
2024 January Network Connection
Effective Jan. 1, 2024, Presbyterian expanded its contractual relationship with Optum Care Network of New Mexico, LLC, so Optum administers authorization requests and hospital admission notifications for Presbyterian Medicare Advantage members assigned to an Optum-employed primary care provider or to a PCP participating with Optum's IPA network. Claims for all Presbyterian Medicare Advantage members must still be submitted to Presbyterian, and providers who are not contracted with Optum will see no change to their claims process. Members not assigned to an Optum-employed or IPA PCP keep the current authorization and inpatient notification process.

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2024 November Network Connection

Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on Nov. 1, 2024

Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on Oct. 1, 2024

2024 September Network Connection

2024 July Network Connection

2024 May Network Connection

Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on May 1, 2024

2024 March Network Connection

2024 January Network Connection