All Insurance Policy Changes (Page 108)

Continuing from page 107. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Femoroacetabular Impingement Surgery
Regence BlueShield·Effective Oct 1, 2026
This is a new medical policy (effective October 1, 2026) establishing coverage criteria for femoroacetabular impingement (FAI) surgery. The policy requires patients to meet strict criteria including skeletally mature status, moderate-to-severe hip pain unresponsive to 3+ months of conservative therapy, positive clinical impingement signs, imaging confirmation of FAI morphology, and absence of contraindications (advanced osteoarthritis, joint space <2mm, severe femoral retroversion/anteversion, broken Shenton line, or Tonnis angle >13-15 degrees). Billing teams must prepare authorization workflows and documentation requirements before October 1, 2026.
High impact
Artificial Intervertebral Disc
Regence BlueShield·Effective Oct 1, 2026
This is a new medical policy (effective October 1, 2026) establishing coverage criteria for artificial intervertebral disc replacement surgery in cervical and lumbar regions. The policy defines specific medical necessity requirements, patient eligibility criteria (age 18-60), imaging standards, conservative therapy documentation requirements, and contraindications. Billing teams must prepare to implement prior authorization workflows and documentation requirements before the effective date.
High impact
Percutaneous Vertebroplasty, Kyphoplasty, Sacroplasty, and Coccygeoplasty
Regence BlueShield·Effective Oct 1, 2026
New medical policy (SUR107) effective October 1, 2026, establishes coverage criteria for percutaneous vertebroplasty, kyphoplasty, sacroplasty, and coccygeoplasty. Coverage is limited to treatment of no more than three symptomatic vertebral fractures (T5-L5 spine) when conservative therapy fails and specific clinical criteria are met. Procedures on other spinal levels, for sacral/coccygeal insufficiency fractures, and using non-balloon mechanical devices are classified as investigational and non-covered.
Medium impact
Varicose Vein Treatment
Regence BlueShield·Effective Oct 1, 2026
This is a NEW varicose vein treatment prior authorization policy effective October 1, 2026, establishing strict medical necessity criteria for coverage. Treatment now requires documented functional impairment with 3+ months of conservative therapy, specific vein measurements from imaging studies, and incompetence exceeding 0.5 seconds. Multiple ablation and sclerotherapy techniques are classified as investigational. Several procedures previously may have been covered without these requirements.
Medium impact
Cochlear Implants
Regence BlueShield·Effective Oct 1, 2026
This is a NEW cochlear implant coverage policy effective October 1, 2026, establishing medical necessity criteria for cochlear implant implantation and replacement across four scenarios: bilateral hearing loss (standard implants or hybrid systems), and single-sided deafness. The policy defines specific audiometric thresholds, hearing aid trial requirements, contraindications, and documentation requirements that billing and clinical teams must use to determine coverage eligibility.
Medium impact
Low-Level Laser Therapy
Regence BlueShield·Effective Oct 1, 2026
This new policy establishes coverage criteria for low-level laser therapy (photobiomodulation), effective October 1, 2026. Coverage is limited to FDA-approved devices used for prevention of oral mucositis in cancer patients undergoing chemotherapy, radiotherapy, and/or hematopoietic cell transplantation. All other uses are classified as investigational and not covered. Prior authorization with specific clinical documentation is required.
High impact
Help us keep directory information up to date
Harvard Pilgrim Health Care·Identified Jul 7, 2026
Harvard Pilgrim Health Care and Tufts Health Plan now require providers to review and revalidate their directory information every 90 days per the No Surprises Act of 2021. Failure to complete this validation will result in suppression from the provider directories until information is verified. Providers must report changes via CAQH Portal, Provider Change Forms, or facility attestation portals.
High impact
06-30-2026 Community Supports Fax Line and Referral Form Updates IE LA SAC SD
Molina Healthcare·Effective Jul 15, 2026
Molina Healthcare of California has updated all Community Supports referral forms to align with current DHCS requirements and established a new dedicated fax line (833) 305-3130 for CS referrals. Effective July 15, 2026, only the revised forms will be accepted; referrals submitted on outdated forms will be rejected and providers may be required to resubmit using current versions.
Low impact
07-01-2026 Clinical Health Advisory 2026 World Cup SB
Molina Healthcare·Effective Jun 11, 2026
Molina Healthcare of California issued a clinical health advisory for the 2026 FIFA World Cup (June 11–July 19, 2026) recommending heightened clinical vigilance for travel-related and vaccine-preventable diseases. Providers must maintain enhanced awareness for infectious diseases including measles, respiratory viruses, tuberculosis, norovirus, mpox, and others, with prompt identification and reporting of suspected cases. This is an informational advisory with no billing code changes or coverage modifications.
High impact
07-01-2026 Billing Reminder SNF, ICF DD and Subacute Care Facilities IM IE LA SAC SD
Molina Healthcare·Effective Jul 1, 2026
Molina Healthcare of California issued a billing reminder (effective July 1, 2026) for SNF, ICF-DD, and Subacute Care facilities highlighting four common claim denial reasons: duplicate service billing, missing authorization, enrollment discrepancies, and invalid revenue codes. The bulletin emphasizes pre-submission verification of authorization, member eligibility, and revenue code accuracy to reduce denials and processing delays.
High impact
07-01-2026 Medi-Cal Enrollment Restrictions IE LA SAC SD
Molina Healthcare·Effective Jul 1, 2026
Molina Healthcare of California is notifying providers about Medi-Cal enrollment restrictions affecting members in six counties (Riverside, San Bernardino, Los Angeles, Sacramento, San Diego, and IE) who have failed to complete annual redetermination. Members with 'Hold Restrictions' are temporarily ineligible for non-emergency services. Providers must verify eligibility through AVES or Availity, support members in completing redetermination, and understand that retroactive coverage applies only if redetermination is completed within 90 days of termination.
High impact
07-01-2026 2026 Provider Manual Updates IM IE LA OC SAC SD
Molina Healthcare·Effective Jul 1, 2026
Molina Healthcare of California has updated its 2026 Provider Manuals for all lines of business (Marketplace, Medi-Cal, and Medicare) across seven counties. The billing team must review and implement any policy, procedure, and contractual requirement changes contained in these updated manuals, which are effective immediately.
High impact
07-02-2026 Private Duty Nursing CM Responsibilities for Medi-Cal Eligible Members APL 26-009
Molina Healthcare·Effective Jul 2, 2026
Molina Healthcare of California has updated case management responsibilities for Private Duty Nursing (PDN) services under Medi-Cal for members under age 21 (APL 26-009, superseding APL 20-012). The plan now requires enhanced care coordination, monitoring of service delivery, tracking of staffing gaps, and mandatory provider participation in authorization, documentation, and continuity-of-care activities. Providers must promptly report service disruptions and maintain current clinical documentation.
Medium impact
07-02-2026 Skilled Nursing Facility Workforce Quality Incentive Program – APL 26-006 IE LA SAC SD
Molina Healthcare·Effective Jan 1, 2023
Molina Healthcare of California is implementing the Skilled Nursing Facility Workforce Quality Incentive Program (WQIP) under APL 26-006, which provides performance-based supplemental payments to eligible SNF providers for Program Years 2023-2025 based on qualifying bed days and performance metrics. Billing teams must ensure accurate and timely claim submission to capture all qualifying bed days, and must monitor compliance as citations can reduce or eliminate WQIP payments. Molina must issue payments within 45 calendar days of receiving payment exhibits from DHCS or within 30 calendar days of receiving a Clean Claim, whichever is later.
High impact
Attention All Providers: Reminder of Retrospective Authorization Requirements
Nevada Medicaid·Effective Jul 6, 2026
Nevada Medicaid issued a reminder of retrospective authorization requirements with strict timelines: 10 business days for members who become eligible during inpatient stay, 90 calendar days for post-discharge eligibility determination, and 30 calendar days when members switch from MCO to FFS coverage. Documentation must include a focused medical necessity synopsis with only supporting records (not voluminous files) and discharge summaries when applicable.
Medium impact
Regence uses its passion for innovation to make healthcare better
Regence BlueCross BlueShield of Oregon·Identified Jul 7, 2026
Regence announced innovation initiatives including SmartAuth (automated prior authorization with 94% immediate approval rates), AI-powered customer service tools, and strategic investments in virtual care services. This is a company-wide announcement focused on process improvements and new care delivery partnerships rather than a specific billing policy change.
Medium impact
MA08.007av, Medicare Part B vs. Part D Crossover Drugs
Independence Blue Cross·Identified Jul 7, 2026
Failed to analyze policy change
High impact
Chelation therapy policy and billing updates effective Sept. 7
Priority Health·Effective Sep 7, 2026
Priority Health has expanded the diagnosis codes eligible for chelation therapy coverage under medical policy #91077 and implemented automated claim edits. Professional claims edits are already active; facility claims edits will activate September 7, 2026. Claims submitted without compliant diagnosis codes will be denied.
High impact
HASA 22-13
Michigan Medicaid - MDHHS·Identified Jul 7, 2026
Michigan Medicaid is ending COVID-19 pharmacy flexibilities and reinstating signature log and proof of delivery requirements for all pharmacy claims. Pharmacies must now maintain documentation proving beneficiaries received medications (either manual/electronic signatures at pickup or carrier tracking with delivery confirmation for mail delivery), effective upon termination of the COVID-19 PHE flexibilities. Documentation must be retained for 7 years and is subject to audit; non-compliance will result in fund recoupment.
Medium impact
MMP 26-13: Children’s Home and Community-Based Services Waiver (CWP)
Michigan Medicaid - MDHHS·Effective Oct 1, 2025
This is a correction bulletin to MMP 26-07 that updates the MichiCANS Decision Support Model (DSM) for Children's Home and Community-Based Services Waiver (CWP) eligibility criteria. Changes include removing duplicative communication language from age-specific criteria, correcting omitted items in the 6+ age group, and retitling Criterion F to 'Developmental Needs/Autism Spectrum Profile'. These are documentation and eligibility assessment changes, not billing code changes.
High impact
MMP 26-24: Hospital 15-Day Readmissions
Michigan Medicaid - MDHHS·Effective Aug 1, 2026
Michigan Medicaid modifies hospital readmission reimbursement effective August 1, 2026. Readmissions within 15 days to a DIFFERENT hospital for the same condition now receive FULL PAYMENT to both hospitals (separate episodes), whereas readmissions to the SAME hospital for related conditions remain bundled as single episodes. Unrelated readmissions are always separate episodes regardless of hospital.
Low impact
Guidewell Releases Annual Impact Report
Florida Blue·Identified Jul 7, 2026
This is a corporate impact report from GuideWell highlighting 2025 achievements in community health, charitable giving, and healthcare innovation initiatives. It does not contain billing policy changes, reimbursement updates, coding requirements, or operational directives affecting medical billing workflows.
High impact
SFY27 Reimbursement
South Dakota Medicaid·Effective Jul 1, 2026
South Dakota Medicaid is implementing comprehensive reimbursement rate increases effective July 1, 2026, including hospital methodology changes (MS-DRG to APR-DRG), FQHC alternative payment methodology, Care Connect tier rate adjustments, and 1.4% inflationary increases across professional services capped at 100% of Medicare. Billing teams must update fee schedules, verify rate changes for specific procedure codes, and align claims submission to new reimbursement methodologies.
Medium impact
HHSC LTCR Publishes Guidance for Providers Related to the Search Engine for Multi-Agency Reportable Conduct (SEMARC)
Texas Medicaid·Identified Jul 7, 2026
HHSC Long-Term Care Regulation has published Provider Letter 2026-10 informing Texas providers of the implementation of Senate Bill 1849, which established the Search Engine for Multi-Agency Reportable Conduct (SEMARC). This new interagency platform allows authorized users to search for individuals with reportable conduct across multiple state agencies. Providers must understand their responsibilities related to SEMARC compliance and reporting obligations.
High impact
Texas Health and Human Services Commission Publishes Fiscal Year 2025 Financial Compliance Reports Primary Entity Contacts List
Texas Medicaid·Effective Jul 20, 2026
Texas HHSC has launched a new web-based system called STEPS (State of Texas Electronic Provider System) to replace the previous financial compliance reporting process for Medicaid providers. Effective July 20, 2026, providers must ensure their Primary Entity Contact (PEC) email address is correctly registered in both PEMS and STEPS, or financial compliance reports will not populate in the system. The billing team must verify PEC contact information and obtain STEPS system access before the reporting deadline.

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2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 108) | PolicyChanges.app

Femoroacetabular Impingement Surgery

Artificial Intervertebral Disc

Percutaneous Vertebroplasty, Kyphoplasty, Sacroplasty, and Coccygeoplasty

Varicose Vein Treatment

Cochlear Implants

Low-Level Laser Therapy

Help us keep directory information up to date

06-30-2026 Community Supports Fax Line and Referral Form Updates IE LA SAC SD

07-01-2026 Clinical Health Advisory 2026 World Cup SB

07-01-2026 Billing Reminder SNF, ICF DD and Subacute Care Facilities IM IE LA SAC SD

07-01-2026 Medi-Cal Enrollment Restrictions IE LA SAC SD

07-01-2026 2026 Provider Manual Updates IM IE LA OC SAC SD

07-02-2026 Private Duty Nursing CM Responsibilities for Medi-Cal Eligible Members APL 26-009

07-02-2026 Skilled Nursing Facility Workforce Quality Incentive Program – APL 26-006 IE LA SAC SD

Attention All Providers: Reminder of Retrospective Authorization Requirements

Regence uses its passion for innovation to make healthcare better

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

Chelation therapy policy and billing updates effective Sept. 7

HASA 22-13

MMP 26-13: Children’s Home and Community-Based Services Waiver (CWP)

MMP 26-24: Hospital 15-Day Readmissions

Guidewell Releases Annual Impact Report

SFY27 Reimbursement

HHSC LTCR Publishes Guidance for Providers Related to the Search Engine for Multi-Agency Reportable Conduct (SEMARC)

Texas Health and Human Services Commission Publishes Fiscal Year 2025 Financial Compliance Reports Primary Entity Contacts List