All Insurance Policy Changes (Page 106)

Continuing from page 105. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
Look for Your Behavioral Health Provider Satisfaction Survey
BCBS Texas·Effective Aug 1, 2026
Blue Cross and Blue Shield of Texas will conduct an annual Behavioral Health Provider Satisfaction Survey in August 2026 via Press Ganey. Selected behavioral health providers will receive survey invitations by email and/or mail and are requested to complete and return the survey. This is an informational announcement about a satisfaction measurement initiative, not a billing or coverage policy change.
Low impact
[Indiana] Save the Date: July Friday Forum - Dental Presentation
CareSource·Identified Jul 8, 2026
This is an invitation to a CareSource provider education event (Friday Forum) scheduled for July 31, 2026, featuring a comprehensive overview of dental enrollment and claims processes. This is an informational/educational announcement, not a policy change affecting billing operations or coverage.
Medium impact
Statewide Medicaid Managed Care Open Enrollment Begins October 1, 2026
Florida Medicaid·Effective Oct 1, 2026
Florida Medicaid is implementing a statewide managed care open enrollment period from October 1 - November 30, 2026, during which all enrollees can switch plans or remain with their current plan. Plan changes become effective December 1, 2026. Billing teams should expect potential changes in patient plan assignments and may need to update patient records with new plan information starting in December 2026.
High impact
TMHP IAMOnline Activation Email Sent July 7, 2026
Texas Medicaid·Effective Jul 7, 2026
TMHP has sent activation emails to Texas Medicaid providers on July 7, 2026, requiring them to activate their IAMOnline accounts by clicking the activation button in the email. This is a mandatory system login process update for all Texas Medicaid providers and affects how providers access TMHP systems going forward.
Low impact
Look for Your Behavioral Health Provider Satisfaction Survey
BCBS Montana·Effective Aug 1, 2026
Blue Cross Blue Shield of Montana will conduct an annual Behavioral Health Provider Satisfaction Survey in August 2026 administered by Press Ganey. Selected providers will be contacted via email and/or mail to complete the survey online or via printed format. This is an informational notice requiring provider participation only if selected; no billing or claims processing changes are involved.
Low impact
BT2026115: IHCP corrects rate for procedure code 0615T
Indiana Medicaid (IHCP)·Effective Jan 1, 2024
IHCP has corrected the reimbursement rate for procedure code 0615T (Automated eye-movement analysis with interpretation and report) to $107.43, effective retroactively to January 1, 2024. The fee-for-service claim-processing system has been updated to reflect this correction, with no impact to previously submitted claims.
High impact
Coding Update for Behavioral Health Screenings Effective August 1, 2026
Illinois Medicaid - HFS·Effective Aug 1, 2026
Effective August 1, 2026, providers must add modifier U1 (negative screening) or U2 (positive screening with follow-up plan) to CPT code 96127 for behavioral health screenings. Claims submitted without one of these modifiers will be rejected with error code L54. This applies to Illinois Medicaid FFS and HealthChoice Illinois MCO plans. Depression screening codes G8431 and G8510 continue unchanged.
Low impact
Look for Your Behavioral Health Provider Satisfaction Survey
BCBS New Mexico·Effective Aug 1, 2026
Blue Cross and Blue Shield of New Mexico will conduct an annual Behavioral Health Provider Satisfaction Survey in August 2026 via Press Ganey. Selected behavioral health providers will be contacted by email and/or mail to complete the survey, with options for online or paper submission. This is an informational notice requiring no billing workflow changes.
High impact
26-847 Provider Communications Posted Online and Operations Manual Updates for June 2026
Health Net·Effective Jun 9, 2026
Health Net released a comprehensive June 2026 policy update containing multiple provider communications and operations manual changes affecting billing, credentialing, and claims processing. Key changes include new Medi-Cal participation requirements for reimbursement (effective 6/12/26), updated transitions of care (TRC) and emergency department follow-up (FMC) documentation requirements (6/29/26), mandatory notification requirements for provider terminations, and new financial responsibility guidance for transplant services. Billing teams must immediately review affected plan types and implement requirement changes to avoid claim denials.
High impact
26-849 Provider Communications Posted Online and Operations Manual Updates for June 2026
Health Net·Effective Jun 12, 2026
This June 2026 policy update consolidates multiple provider communications and operations manual changes affecting Medi-Cal billing and operations in Imperial County. Key changes include new requirements for rendering provider participation status verification at time of service, expanded PPG/hospital termination notification requirements, updated HEDIS measurement guidance, dyadic behavioral health billing clarifications, and new financial responsibility guidelines for transplant services.
High impact
26-850 Provider Communications Posted Online and Operations Manual Updates for June 2026
Health Net·Effective Jun 9, 2026
CalViva Health released June 2026 provider updates including five new communications and three operations manual changes affecting Medi-Cal providers in Fresno, Kings, and Madera counties. Key updates include mandatory notification requirements for PPG/hospital terminations (effective 6/9/26), new reimbursement participation requirements clarifying rendering provider credentialing (effective 6/12/26), updated access to care standards, HEDIS measurement guidance, appointment wait time standards, clinical policy updates, and financial responsibility guidelines for transplant services.
High impact
MAB2026070103
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (Medicaid) updated prior authorization requirements for Lipotropics, Other medications effective July 6, 2026. The policy adds new drug classes requiring prior authorization (including the newly FDA-approved Redemplo/plozasiran), revises statin trial requirements, updates cholesterol goal metrics to include non-HDL-C and apoB, and adds renewal guidelines for non-preferred PCSK9 inhibitors. Pharmacies and prescribers must follow updated clinical review guidelines when submitting prior authorization requests.
Medium impact
MAB2026070101
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance updated prior authorization guidelines for estrogen prescriptions effective July 6, 2026, differentiating between systemic and vaginal estrogen preparations. The policy now requires prior authorization for non-preferred estrogens and those exceeding quantity limits, with specific clinical review criteria including FDA approval, therapeutic failure of preferred alternatives, and for gender dysphoria cases, treatment by an endocrinologist or transgender medicine specialist following WPATH standards.
High impact
MAB2026063004
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (MA) program has updated prior authorization requirements for Cytokine and CAM Antagonist medications, effective July 6, 2026. The policy establishes comprehensive clinical review guidelines for determining medical necessity, including new requirements for specialist consultation, tuberculosis/hepatitis B screening, mental health evaluation for specific drugs, and disease-specific criteria for Crohn's disease, ulcerative colitis, rheumatoid arthritis, and juvenile idiopathic arthritis. All pharmacies and prescribers enrolled in MA must follow these updated requirements for fee-for-service and managed care beneficiaries.
High impact
MAB2026063001
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance updated prior authorization requirements for COPD agents effective July 6, 2026. New guidelines add coverage for phosphodiesterase 3 and 4 inhibitors (Daliresp/roflumilast and Ohtuvayre/ensifentrine) with specific clinical criteria including GOLD-guideline-based severity documentation, mental health evaluation requirements, and therapeutic failure documentation. All pharmacies and prescribers enrolled in PA MA must follow updated clinical review guidelines for PA requests.
High impact
MAB2026070102
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance updated prior authorization requirements for intra-articular hyaluronate injections, effective July 6, 2026. The key change clarifies that renewal requests must document improvement following the MOST RECENT treatment (not the first treatment). All intra-articular hyaluronate prescriptions now require prior authorization; renewals require documented pain/joint function improvement, no prior injection in same joint within 6 months, and failure of preferred agents for non-preferred products.
High impact
MAb2026063002
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance (MA) Program has updated prior authorization requirements for antipsychotic medications effective July 6, 2026. The policy establishes new clinical review guidelines for non-preferred antipsychotics, pediatric antipsychotics, and therapeutic duplication scenarios. Pharmacies and prescribers must now follow revised documentation and approval criteria including FDA-approved indications, dosing consistency, and for pediatric cases, comprehensive evaluations and baseline metabolic monitoring.
High impact
MAB2026063003
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance updated prior authorization requirements for Amyloid-Targeted Monoclonal Antibodies (MABs), effective July 6, 2026. The policy consolidates guidelines for Leqembi and Kisunla under unified clinical criteria, removes outdated Aduhelm guidelines, and establishes strict documentation requirements including cognitive testing scores, baseline MRI, biomarker confirmation, dementia specialist oversight, and quarterly monitoring for all MAB prescriptions and renewals.
High impact
MAB2026070104
Pennsylvania Medicaid (DHS)·Effective Jul 6, 2026
Pennsylvania Medical Assistance updated prior authorization requirements for drugs exceeding quantity limits and daily dose limits effective July 6, 2026. The policy revises clinical review guidelines to address partial-unit dosing, multi-unit consolidation, titration packs, medical reasons for frequent dosing, and documentation of lower-dose ineffectiveness. Prescribers and pharmacies must now submit prior authorization requests that align with these updated criteria.
Medium impact
MA00.037o, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Independence Blue Cross·Identified Jul 8, 2026
Failed to analyze policy change
High impact
MA08.007aw, Medicare Part B vs. Part D Crossover Drugs
Independence Blue Cross·Effective Jul 1, 2026
Policy MA08.007aw addresses Medicare Advantage coverage distinctions between Part B and Part D crossover drugs—medications that can be covered under either pharmacy (Part D) or medical benefit (Part B) depending on administration method and clinical context. This policy clarifies billing and coverage rules to prevent improper claim routing and ensure correct benefit application for affected drugs.
Medium impact
00.10.39s, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located Within a Facility or on a Facility Campus
Independence Blue Cross·Identified Jul 8, 2026
Failed to analyze policy change
High impact
Justice-Involved (JI) Reentry Initiative: Medi-Cal Fee-for-Service Reimbursement Methodology
Medi-Cal·Effective Jul 6, 2026
Medi-Cal clarifies that Justice-Involved (JI) pre-release services use standard fee-for-service reimbursement methodology with no separate JI billing structure. Providers must apply unit values, conversion factors, split billing rules for professional/technical components, timely filing penalties, and specific JI adjustments (Modifier QJ 10% bump offset by 1% W&I Code 14105.191 reduction) to calculate accurate reimbursement.
High impact
Medical and Clinical Policy Updates - Effective October 1, 2026
Sentara Health Plans·Effective Oct 1, 2026
Sentara Health Plans has updated 18 medical policies effective October 1, 2026, including archiving 4 policies (Nasal Repair, Wearable External Cardioverter Defibrillators, Vitrectomy Face-Down Positioning, Computer Assisted Navigation) and revising or reviewing coverage for surgical procedures, DME, and medical devices across cardiac, orthopedic, and dermatologic services. Billing teams must immediately access the full policy text at sentarahealthplans.com and pal.sentarahealthplans.com to identify specific billing code impacts and prior authorization requirement changes for affected procedures.
Low impact
[California] Coordinate patient care in minutes, not hours
Anthem BCBS·Identified Jul 7, 2026
Anthem Blue Cross Medicare Advantage is promoting Alerts Hub, a new application within Availity Essentials that sends daily email notifications for admissions, discharges, transfers, and care coordination events for Special Needs Plans (SNPs) patients. This tool is designed to streamline care coordination tracking and improve HEDIS and Medicare Stars performance metrics.

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Archive by year

2023 2024 2025 2026

Look for Your Behavioral Health Provider Satisfaction Survey

[Indiana] Save the Date: July Friday Forum - Dental Presentation

Statewide Medicaid Managed Care Open Enrollment Begins October 1, 2026

TMHP IAMOnline Activation Email Sent July 7, 2026

Look for Your Behavioral Health Provider Satisfaction Survey

BT2026115: IHCP corrects rate for procedure code 0615T

Coding Update for Behavioral Health Screenings Effective August 1, 2026

Look for Your Behavioral Health Provider Satisfaction Survey

26-847 Provider Communications Posted Online and Operations Manual Updates for June 2026

26-849 Provider Communications Posted Online and Operations Manual Updates for June 2026

26-850 Provider Communications Posted Online and Operations Manual Updates for June 2026

MAB2026070103

MAB2026070101

MAB2026063004

MAB2026063001

MAB2026070102

MAb2026063002

MAB2026063003

MAB2026070104

MA00.037o, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

MA08.007aw, Medicare Part B vs. Part D Crossover Drugs

00.10.39s, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located Within a Facility or on a Facility Campus

Justice-Involved (JI) Reentry Initiative: Medi-Cal Fee-for-Service Reimbursement Methodology

Medical and Clinical Policy Updates - Effective October 1, 2026

[California] Coordinate patient care in minutes, not hours

Look for Your Behavioral Health Provider Satisfaction Survey

Look for Your Behavioral Health Provider Satisfaction Survey

Look for Your Behavioral Health Provider Satisfaction Survey