All Insurance Policy Changes (Page 107)

Continuing from page 106. 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
[New York] Coordinate patient care in minutes, not hours
Anthem BCBS·Identified Jul 7, 2026
Anthem Blue Cross and Blue Shield Medicare Advantage is promoting Alerts Hub, a care coordination tool within Availity Essentials that provides daily email notifications for patient admissions, discharges, transfers, and behavioral health events. This is an informational bulletin about an existing operational tool designed to improve HEDIS and Stars metrics performance for Special Needs Plans (SNPs), not a coverage or billing policy change.
Medium impact
[Ohio] Precertification/prior authorization list change notification
Anthem BCBS·Effective Dec 1, 2026
Anthem Blue Cross and Blue Shield (Ohio) is adding 14 new services to its precertification/prior authorization requirements effective December 1, 2026. These additions include four specialized laboratory tests (Alzheimer's biomarkers, IBS serology, infectious disease sequencing, prostate cancer protein biomarkers), two irreversible electroporation procedures, six carotid sinus baroreceptor stimulation device codes, and two gene therapy treatments. All affected services will require prior authorization before billing to avoid claim denials.
High impact
[Ohio] Avoid delays: LTC/custodial care authorization FAQs for MyCare Ohio care providers
Anthem BCBS·Effective Jul 6, 2026
Anthem MyCare Ohio has issued updated guidance on long-term care (LTC) and custodial care prior authorization requirements. Key clarifications include: authorizations approved for January 1, 2026 will be extended through year-end if all required information was submitted; assisted living per diem (T2031) requires prior authorization; no retroactive authorizations are permitted; and the Floor to SNF program does not apply to MyCare members. Billing teams must ensure all LTC/custodial care authorization requests include clinical documentation, PASRR, and Level of Care forms to avoid claim denials.
Medium impact
[Ohio] Coordinate patient care in minutes, not hours
Anthem BCBS·Effective Jul 6, 2026
Anthem Blue Cross and Blue Shield (Ohio) is promoting the use of Alerts Hub, a new application within the Anthem Payer Space in Availity Essentials, to streamline care coordination for Medicare Advantage Special Needs Plans (SNPs) patients. This tool provides daily email notifications for admissions, discharges, transfers, and behavioral health events to reduce care coordination time and improve HEDIS and Stars metrics performance.
Low impact
[Ohio] Coordinate patient care in minutes, not hours
Anthem BCBS·Identified Jul 7, 2026
Anthem MyCare Ohio is promoting Alerts Hub, a care coordination tool within Availity Essentials that sends daily notifications for patient admissions, discharges, transfers, and behavioral health events. This is an informational bulletin encouraging providers to use an existing application to improve care coordination and HEDIS/Stars performance metrics; no billing process changes are mandated.
Low impact
[Virginia] Coordinate patient care in minutes, not hours
Anthem BCBS·Identified Jul 7, 2026
Anthem Blue Cross and Blue Shield (Virginia) is promoting the use of Alerts Hub, a tool within Anthem Payer Space in Availity Essentials, to streamline care coordination for Special Needs Plan (SNP) patients. This tool provides daily email notifications for admissions, discharges, transfers, and behavioral health events to reduce care coordination time and improve HEDIS and Medicare Stars performance metrics. This is an informational bulletin about an existing tool, not a new billing requirement.
Low impact
[Georgia] Coordinate patient care in minutes, not hours
Anthem BCBS·Identified Jul 7, 2026
Anthem Blue Cross and Blue Shield (Georgia) is promoting the use of Alerts Hub, a tool within Availity Essentials that provides daily email notifications for Special Needs Plans (SNPs) patients to streamline care coordination around admissions, discharges, transfers, and care plan updates. This is an informational bulletin about an existing application feature designed to improve HEDIS and Medicare Stars performance metrics, not a new billing or coverage requirement.
Low impact
Summary of Provider Newsroom behavioral health articles
Cigna·Identified Jul 7, 2026
This is a summary document of behavioral health articles published in the Cigna Provider Newsroom for June 2026. It is not a policy change but rather a compilation of links and highlights to existing policies and initiatives, including updates on mental health screening requirements, behavioral health appeal submission procedures, and 270/271 eligibility enhancements.
Medium impact
Summary of Provider Newsroom U.S. commercial medical articles
Cigna·Effective Jul 1, 2026
This is a newsroom summary document listing June 2026 provider articles from Cigna Healthcare, not an actionable policy change. Key items include: (1) Clearity copay-only medical plan launches July 1, 2026; (2) 270/271 eligibility transactions now include NPI-specific tiered benefit information; (3) Claims submission enhancements will flag billing errors in real-time to reduce denials; (4) Behavioral health appeals should be submitted to Evernorth Behavioral Health, not Cigna Healthcare.
High impact
Surgical Site of Care - Colonoscopy and Sigmoidoscopy
Regence BlueShield·Effective Jul 1, 2026
This new policy establishes prior authorization requirements for colonoscopy and sigmoidoscopy procedures performed in hospital outpatient departments instead of ambulatory surgery centers (ASCs) or physician offices. The policy defines 27 specific medical criteria (A-CC) that must be met for hospital outpatient site of care to be considered medically necessary. Procedures not meeting these criteria will require denial or redirection to ASC/office settings.
High impact
Surgical Site of Care- Hospital Outpatient
Regence BlueShield·Effective Oct 1, 2026
This policy establishes prior authorization requirements for surgical procedures performed in hospital outpatient departments instead of ambulatory surgery centers (ASCs) or physician offices. The policy defines 30 specific medical criteria that must be met for hospital outpatient site of care to be considered medically necessary. A revised version becomes effective October 1, 2026, requiring immediate workflow updates to billing systems and prior authorization processes.
High impact
Hysterectomy
Regence BlueShield·Effective Jul 1, 2026
This new hysterectomy prior authorization policy (effective July 1, 2026) establishes specific medical necessity criteria for hysterectomy procedures across nine clinical indications. Billing teams must now obtain prior authorization and ensure clinical documentation supports one of nine approved conditions before submitting claims. Claims submitted without meeting these criteria or proper documentation will be denied.
High impact
Lumbar Spinal Fusion
Regence BlueShield·Effective Jul 1, 2026
This is a new Medical Policy (SUR187) effective July 1, 2026, establishing comprehensive coverage criteria for lumbar spinal fusion procedures. The policy requires strict documentation of medical necessity, including imaging confirmation, conservative treatment failure (minimum 3 months), functional disability assessment, and nicotine abstinence verification before surgery is considered covered. Billing teams must implement prior authorization workflows to validate all seven coverage pathways (fracture/instability, infection repair, stenosis, idiopathic scoliosis, degenerative scoliosis, isthmic spondylolisthesis, and recurrent stenosis/herniation).
High impact
Spinal Cord and Dorsal Root Ganglion Stimulation
Regence BlueShield·Effective Jul 1, 2026
This is a new medical policy effective July 1, 2026, establishing coverage criteria for spinal cord stimulation (standard, high-frequency) and dorsal root ganglion stimulation procedures. The policy requires strict pre-authorization documentation including 6+ months of failed conservative therapy, psychiatric/behavioral health clearance, and a 50% pain reduction threshold during trial periods before permanent implantation. Billing teams must implement documentation requirements and prior authorization processes immediately to prevent claim denials.
Medium impact
Histotripsy for Tumor Treatment
Regence BlueShield·Effective Jul 1, 2026
Effective July 1, 2026, histotripsy for tumor treatment is classified as investigational for any indication and is NOT covered. Providers must obtain prior authorization and inform patients they will be financially responsible for this procedure. Claims for histotripsy will be denied for all patients.
Medium impact
Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products
Regence BlueShield·Identified Jul 7, 2026
Failed to analyze policy change
High impact
New and Emerging Medical Technologies and Procedures
Regence BlueShield·Effective Jul 1, 2026
Effective July 1, 2026, this policy designates 50+ new and emerging medical technology CPT codes (0075T through 0505T) as investigational and therefore non-covered services. Billing teams must immediately identify these codes in their systems and flag them for patient financial responsibility notices before service delivery. Providers may bill members directly for these investigational procedures, but members must be informed in advance that they will be responsible for costs.
Medium impact
Lyme Disease Testing
Regence BlueShield·Effective Jul 1, 2026
Effective July 1, 2026, nine proprietary Lyme disease tests (from IGeneX, ID-FISH Technology, and Galaxy Diagnostics) are classified as investigational and non-covered. Billing teams must deny claims for these specific tests and inform providers that members may be billed directly, as these tests fall outside standard CDC-recommended two-step serologic testing protocols.
High impact
Investigational Gene Expression, Biomarker, and Multianalyte Testing
Regence BlueShield·Effective Jul 1, 2026
Effective July 1, 2026, this new policy establishes that investigational gene expression, biomarker, and multianalyte tests are NOT covered by insurance. The policy lists 80+ specific tests (including MindX™, aiSLE™ DX, DecisionDx®-SCC, and others) as investigational due to insufficient evidence of clinical utility. Providers may bill patients directly for these tests, but must inform patients in advance that they will be financially responsible.
High impact
Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid Biopsy) of Solid Tumor Cancers
Regence BlueShield·Effective Jul 1, 2026
New policy (LAB46) effective July 1, 2026 establishes coverage criteria for liquid biopsy testing (circulating tumor DNA and circulating tumor cells) in solid tumor cancers. Coverage is limited to two scenarios: (1) advanced/metastatic ER-positive, HER2-negative breast cancer, or (2) cases where tissue testing is impossible AND the test includes genes with FDA-approved targeted therapies. All other liquid biopsy uses (MRD testing, cancer screening, urine tests) are classified as investigational and not covered. Prior authorization is required.
High impact
Evaluating the Utility of Genetic Panels
Regence BlueShield·Effective Jul 1, 2026
This new policy (effective July 1, 2026) establishes coverage criteria for genetic panel tests, designating panels without demonstrated clinical utility for their genes as investigational. The policy provides a comprehensive list of genetic panels across multiple laboratories and conditions that require clinical documentation to support medical necessity. Billing teams must verify that genetic panel tests ordered have documented clinical utility before submitting claims, as investigational panels will be denied.
Medium impact
Tonic Motor Activation (TOMAC) for Restless Legs Syndrome
Regence BlueShield·Effective Jul 1, 2026
Effective July 1, 2026, Tonic Motor Activation (TOMAC) for Restless Legs Syndrome is classified as investigational and is NOT covered. Billing teams must deny all TOMAC claims and inform patients they are financially responsible for costs. This is a new policy establishing non-coverage status.
Medium impact
Functional Neuromuscular Electrical Stimulation
Regence BlueShield·Effective Jul 1, 2026
This new policy (effective July 1, 2026) classifies all Functional Neuromuscular Electrical Stimulation (FNMES) devices and treatments as investigational for ALL indications, including spinal cord injury rehabilitation, stroke recovery, foot drop correction, and pain management. Billing teams must deny all claims for these devices and notify patients that they may be financially responsible.
Medium impact
Myoelectric and Microprocessor Prosthetic and Orthotic Components for the Upper Limb
Regence BlueShield·Identified Jul 7, 2026
Failed to analyze policy change
High impact
Surgical Site of Care - Hospital Outpatient
Regence BlueShield·Effective Oct 1, 2026
This new policy establishes prior authorization requirements for surgical procedures performed in hospital outpatient departments instead of ambulatory surgery centers (ASCs) or physician offices, effective October 1, 2026. The policy defines 30 specific medical necessity criteria that must be met for hospital outpatient site of care to be covered, including patient age, comorbidities, medication interactions, and procedure complexity. Billing teams must implement prior authorization workflows and ensure proper documentation to support medical necessity claims.

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Archive by year

2023 2024 2025 2026

[New York] Coordinate patient care in minutes, not hours

[Ohio] Precertification/prior authorization list change notification

[Ohio] Avoid delays: LTC/custodial care authorization FAQs for MyCare Ohio care providers

[Ohio] Coordinate patient care in minutes, not hours

[Ohio] Coordinate patient care in minutes, not hours

[Virginia] Coordinate patient care in minutes, not hours

[Georgia] Coordinate patient care in minutes, not hours

Summary of Provider Newsroom behavioral health articles

Summary of Provider Newsroom U.S. commercial medical articles

Surgical Site of Care - Colonoscopy and Sigmoidoscopy

Surgical Site of Care- Hospital Outpatient

Hysterectomy

Lumbar Spinal Fusion

Spinal Cord and Dorsal Root Ganglion Stimulation

Histotripsy for Tumor Treatment

Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products

New and Emerging Medical Technologies and Procedures

Lyme Disease Testing

Investigational Gene Expression, Biomarker, and Multianalyte Testing

Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid Biopsy) of Solid Tumor Cancers

Evaluating the Utility of Genetic Panels

Tonic Motor Activation (TOMAC) for Restless Legs Syndrome

Functional Neuromuscular Electrical Stimulation

Myoelectric and Microprocessor Prosthetic and Orthotic Components for the Upper Limb

Surgical Site of Care - Hospital Outpatient