All Insurance Policy Changes (Page 1109)

Continuing from page 1108. 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
Reinforce Prenatal and Postpartum Care to Support Whole Health
BCBS Oklahoma·Effective Apr 16, 2026
Blue Cross Blue Shield of Oklahoma is reinforcing their focus on prenatal and postpartum care quality measures, including depression screening requirements. This policy emphasizes proper documentation and timing of prenatal visits, postpartum care visits, and mandatory depression screening with follow-up protocols to meet HEDIS quality measures.
Low impact
Coding for Annual Wellness Visits: Earn Continuing Education Unit
BCBS Oklahoma·Effective Apr 24, 2026
A free continuing education webinar on coding for annual wellness visits for Medicare Advantage members is being offered on April 24, 2026, from noon to 1 p.m. The training provides one CEU from the American Academy of Professional Coders and covers documentation standards, coding requirements, and common coding errors.
Low impact
See Our Behavioral Health Resources for Providers
BCBS Oklahoma·Effective Apr 23, 2026
Blue Cross Blue Shield of Oklahoma has published comprehensive behavioral health resources for providers, including clinical practice guidelines, free continuing education webinars, HEDIS documentation guidance, and care management program information. This is an informational resource compilation rather than a policy change affecting billing procedures.
High impact
New Claims Editing Rules To Be Implemented in July 2026
BCBS Oklahoma·Effective Jul 15, 2026
New claims editing rules will be implemented in July 2026 affecting multiple procedure codes and billing scenarios. These automated edits will result in claim denials or payment adjustments for various issues including missing modifiers, incorrect diagnosis sequencing, and inappropriate code combinations.
Medium impact
OfficeLink Updates - September 2024 newsletter
Aetna·Effective Jan 1, 2025
Aetna Passport to Healthcare members may show as ineligible in EDI 270/271 transactions, but providers must call the phone number provided instead of turning members away. Immunization/vaccine coding changes scheduled for March 2024 have been cancelled, and pharmacist reimbursement changes take effect January 1, 2025.
High impact
OfficeLink Updates - October 2024 notices and reminders (PDF)
Aetna·Effective Jan 1, 2025
Aetna is implementing multiple changes including new precertification requirements for specialty drugs (effective September-October 2024), pathology billing restrictions with Mohs surgeries, and several claim edits starting January 1, 2025. Most significantly, pathology codes will be denied when billed same-day as Mohs procedures unless for separate lesions.
Medium impact
OfficeLink Updates - December 2024 newsletter
Aetna·Effective Mar 1, 2025
Aetna is discontinuing certain live training webinars and transitioning to Availity's on-demand training options. New claim edits will be implemented starting March 1, 2025, as part of the Claim and Code Review Program (CCRP) for commercial, Medicare and Student Health members.
High impact
OfficeLink Updates - February 2025 notices and reminders (PDF)
Aetna·Effective Feb 1, 2025
Aetna is implementing multiple billing changes including new precertification requirements for several drugs and procedures, eliminating facility fee reimbursement for hospital-owned practices when physician fees are already paid, and requiring adherence documentation codes for CPAP supplies.
Medium impact
OfficeLink Updates - March 2025 newsletter
Aetna·Effective Jun 1, 2025
Aetna's March 2025 newsletter announces new claim edits starting June 1, 2025 for their Claim and Code Review Program (CCRP), along with commercial drug list changes effective July 1, 2025. These changes affect commercial, Medicare and Student Health members and can be viewed on Availity.
Medium impact
OfficeLink Updates - May 2025 notices and reminders (PDF)
Aetna·Effective Jul 1, 2025
Effective August 1, 2025, Aetna will no longer cover surgical pathology code 88305 when billed with prostate procedures 55700/55706 on the same date, and will limit G0416 to once per date of service. Additionally, effective July 1, 2025, certain specialty medications will move between medical and pharmacy benefits for fully insured commercial members.
High impact
OfficeLink Updates - July 2025 notices and reminders (PDF)
Aetna·Effective Jun 18, 2025
Aetna has updated its National Precertification List (NPL) with multiple changes effective June-July 2025, requiring new prior authorization for several specialty drugs (denosumab, ustekinumab, tocilizumab variants) while removing precertification requirements for electric scooters, orthognathic surgery, TMJ procedures, and Medicare hyperbaric oxygen therapy. Additionally, certain oncology immune checkpoint inhibitors will have reduced 90-day initial approval periods when administered in outpatient hospital settings starting October 1, 2025.
High impact
OfficeLink Updates - August 2025 notices and reminders (PDF)
Aetna·Effective Aug 1, 2025
Aetna is implementing three major changes: a new payment structure for Medicare inpatient stays 1+ midnight that pays faster at observation rates with appeal rights, new CPT code requirements for lesion excisions based on tissue depth, and expanded precertification requirements for multiple specialty drugs including biosimilars.
High impact
OfficeLink Updates - October 2025 notices and reminders (PDF)
Aetna·Effective Jan 1, 2026
Aetna is implementing multiple policy changes effective January 1, 2026, including new prior authorization requirements for inpatient rehabilitation, skilled nursing, and home health services in select states, plus updates to specialty drug administration policies and compression stocking coverage exclusions.
High impact
OfficeLink Updates - November 2025 notices and reminders (PDF)
Aetna·Effective Nov 1, 2025
Aetna is implementing multiple prior authorization changes for specialty drugs and procedures, removing precertification requirements for artificial insemination procedures, and requiring valid CPT/HCPCS codes for behavioral health services. Key changes take effect at various dates from November 2025 through February 2026.
Medium impact
OfficeLink Updates - November 2025 notices and reminders - edition 11/6/25 (PDF)
Aetna·Effective Jan 1, 2026
Aetna has delayed implementation of their Level of Severity Inpatient Payment Policy from November 15, 2025 to January 1, 2026. The policy will only apply severity reviews to urgent/emergent inpatient stays of 1-4 midnights for Medicare and SNP members, while stays of 5+ midnights will automatically be paid at the inpatient DRG rate.
High impact
OfficeLink Updates - January 2026 notices and reminders (PDF)
Aetna·Effective Apr 1, 2026
Aetna is implementing multiple policy changes effective April 1, 2026, including new prior authorization requirements for specialty drugs and procedures, bundling of medication-assisted treatment services, updated coding rules for ventral hernias, and new modifier requirements for reduced/discontinued services.
High impact
OfficeLink Updates - February 2026 notices and reminders (PDF)
Aetna·Effective Apr 1, 2026
Aetna is adding precertification requirements for 16 new specialty drugs and medical injectables, with most changes effective April 1, 2026. Additionally, Site of Care requirements will apply to two specific drugs for commercial plans starting April 1, 2026.
High impact
OfficeLink Updates - April 2026 notices and reminders (PDF)
Aetna·Effective Jul 1, 2026
Aetna is implementing multiple policy changes effective July 1, 2026, including updates to pharmacy drug lists, Combined Benefit Management drug list changes that may move specialty drugs between medical and pharmacy benefits, and new billing restrictions for reconstructive surgery codes when performed with breast or digestive system surgeries. Remote Physiologic Monitoring coverage is now limited to heart failure, hypertension, and diabetes only.
High impact
OfficeLink Updates - May 2026 notices and reminders (PDF)
Aetna·Effective May 1, 2026
Aetna has updated their National Precertification List with multiple changes taking effect between May 2026 and January 2027. Several drugs will now require precertification including ustekinumab-srlf, ranibizumab-nuna, and others, while Fulphila will no longer require precertification for Medicare patients.
Medium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Aug 1, 2026
Starting August 1, 2026, CPT code C1607 (integrated neurostimulator implant) will require precertification/prior authorization through Carelon Medical Benefits Management for New York Medicaid patients. Providers must obtain authorization before performing these procedures to avoid claim denials.
Medium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, CPT code C1607 (neurostimulator, integrated implantable, rechargeable) will require precertification/prior authorization through Carelon Medical Benefits Management for Ohio Medicaid patients. Providers can submit authorization requests through Carelon's provider portal or Availity Essentials.
Low impact
[Ohio] Referral Dashboard in Care Central — update to Phase 2 service referrals for MyCare LTSS providers
Anthem BCBS·Identified Jun 19, 2026
Anthem MyCare Ohio is updating their Referral Dashboard in Care Central for LTSS providers. Phase 2 service referrals (including home care, personal care aids, and assisted living) will move from phone/email to the dashboard system in fall 2026.
Medium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Aug 1, 2026
Starting August 1, 2026, Virginia Medicaid will require precertification/prior authorization for CPT code C1607 (rechargeable neurostimulator implant) through Carelon Medical Benefits Management. This affects sleep medicine procedures involving implantable neurostimulator devices.
Low impact
[Virginia] Precertification list change notification
Anthem BCBS·Effective Jan 1, 2027
Anthem Blue Cross and Blue Shield is adding Gene Therapy for Wiskott-Aldrich Syndrome (MED.00161) to their precertification requirements effective January 1, 2027. This rare genetic disorder treatment will now require prior authorization before services can be rendered to avoid reimbursement complications.
Low impact
[Georgia] Precertification list change notification
Anthem BCBS·Effective Jan 1, 2027
Anthem Blue Cross and Blue Shield Georgia is adding Gene Therapy for Wiskott-Aldrich Syndrome (MED.00161) to their precertification requirements effective January 1, 2027. This specialized gene therapy will require prior authorization before treatment to avoid reimbursement complications.

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Archive by year

2023 2024 2025 2026

Reinforce Prenatal and Postpartum Care to Support Whole Health

Coding for Annual Wellness Visits: Earn Continuing Education Unit

See Our Behavioral Health Resources for Providers

New Claims Editing Rules To Be Implemented in July 2026

OfficeLink Updates - September 2024 newsletter

OfficeLink Updates - October 2024 notices and reminders (PDF)

OfficeLink Updates - December 2024 newsletter

OfficeLink Updates - February 2025 notices and reminders (PDF)

OfficeLink Updates - March 2025 newsletter

OfficeLink Updates - May 2025 notices and reminders (PDF)

OfficeLink Updates - July 2025 notices and reminders (PDF)

OfficeLink Updates - August 2025 notices and reminders (PDF)

OfficeLink Updates - October 2025 notices and reminders (PDF)

OfficeLink Updates - November 2025 notices and reminders (PDF)

OfficeLink Updates - November 2025 notices and reminders - edition 11/6/25 (PDF)

OfficeLink Updates - January 2026 notices and reminders (PDF)

OfficeLink Updates - February 2026 notices and reminders (PDF)

OfficeLink Updates - April 2026 notices and reminders (PDF)

OfficeLink Updates - May 2026 notices and reminders (PDF)

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Ohio] Referral Dashboard in Care Central — update to Phase 2 service referrals for MyCare LTSS providers

[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Virginia] Precertification list change notification

[Georgia] Precertification list change notification