All Insurance Policy Changes (Page 111)

Continuing from page 110. 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
PDS Transition Memo - Second Notice
Kentucky Medicaid·Effective Jul 1, 2026
Kentucky is transitioning oversight of Participant Directed Services (PDS) from the Department for Aging and Independent Living (DAIL) to waiver operating agencies. Critical incident reporting, mortality reviews, inability to access services, and involuntary termination tasks will transition to operating agencies effective July 1, 2026, with full PDS transition anticipated by January 1, 2027. Case managers must attend mandatory training on August 5, 2026 to learn revised PDS standard operating procedures.
High impact
BT2026111: IHCP discontinues use of JG modifier to indicate 340B drugs on medical claims
Indiana Medicaid (IHCP)·Effective Aug 1, 2026
The Indiana Health Coverage Programs (IHCP) is discontinuing the JG modifier for 340B drugs on medical claims effective August 1, 2026. Providers must use the TB modifier instead to identify 340B-acquired drugs on physician-administered drug claims for IHCP members. Claims submitted with the JG modifier for DOS on or after August 1, 2026 will no longer be accepted.
Medium impact
BT2026112: IHCP posting FFS payment rates per final rule transparency requirements
Indiana Medicaid (IHCP)·Effective Jul 1, 2026
Indiana Medicaid (IHCP) has published all FFS payment rates and comparative payment rate analyses as required by federal transparency rules (effective July 1, 2026). All billing teams must verify current rates for their service lines on the IHCP Fee Schedules webpage or applicable partner sites (Myers and Stauffer, Optum Rx) to ensure accurate claim submission and reimbursement.
Medium impact
BT2026113: IHCP presents status of claim-processing payment for impacted CCBHC claims
Indiana Medicaid (IHCP)·Identified Jul 3, 2026
IHCP is processing system corrections for CCBHC claims affected by a January 28, 2026 system implementation. Two specific issues are being resolved: (1) Members with third-party liability for optical coverage experiencing erroneous claim denials, and (2) Members in the 590 Program receiving incorrect denials with EOB code 2033. Providers should NOT resubmit claims as IHCP will automatically reprocess them as system updates are completed.
High impact
BT2026114: IHCP clarifies FQHC and RHC billing procedures for vision services
Indiana Medicaid (IHCP)·Effective Jul 2, 2026
IHCP clarifies billing procedures for vision services at FQHCs and RHCs, requiring all vision services to be billed on professional claims with HCPCS code T1015 and a valid encounter code. When eyeglasses are picked up on a separate date from the eye exam, providers have two options: submit one combined claim (eligible for PPS rate) or submit separate claims for exam and materials (materials-only claim must be denied). Materials are limited to basic frames and lenses; upgrades and non-medically-necessary contact lenses are member responsibility with advance notification required.
High impact
Hospital Average Commercial Rate (ACR) Data Collection
Illinois Medicaid - HFS·Effective Jan 1, 2027
Illinois hospitals must submit Average Commercial Rate (ACR) data for their five highest-volume commercial payers to demonstrate compliance with federal Medicaid managed care payment limits. This data collection is required to maintain directed payment eligibility for calendar year 2027. Data submission is mandatory by July 31, 2026, through a secure portal managed by Milliman.
High impact
2026-07-02 - CY 2027 Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Proposed Rule
Medicare/CMS·Identified Jul 3, 2026
CMS issued a proposed rule for CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment updates, including revised payment rates, expanded volume control methods, reduced 340B drug payments, elimination of the inpatient-only list, and new prior authorization requirements for botulinum toxin injection codes. This is a proposed rule requiring comment period completion before final implementation.
High impact
26-824 Follow New Maternity Care Requirements to Avoid Claim Delays
Health Net·Effective Jan 1, 2026
Medi-Cal has implemented new maternity care requirements effective January 1, 2026, requiring providers to complete risk assessments at initial visit, each trimester, and postpartum; document screening results and patient opt-outs for the California Prenatal Screening Program; and offer referrals to behavioral health, lactation, doula, and Community Health Worker services. Prior authorization is now required for basic prenatal, maternal, and preventive services with standard turnaround of 5 business days (not to exceed 7 calendar days) or 72 hours for urgent cases. Claims may be delayed if documentation and opt-out status are not properly recorded.
High impact
26-825 Follow New Maternity Care Requirements to Avoid Claim Delays
Health Net·Effective Jan 1, 2026
Medi-Cal maternity care requirements have been updated effective January 1, 2026, requiring providers to complete risk assessments at specific intervals, document screening results and patient opt-outs, provide prenatal education, and coordinate expanded support services (doula, lactation, behavioral health). Prior authorization is now required for basic prenatal, maternal, and preventive services with 5-7 business day standard timelines. Failure to comply will result in claim processing delays.
High impact
26-826 Follow New Maternity Care Requirements to Avoid Claim Delays
Health Net·Effective Jan 1, 2026
Medi-Cal maternity care requirements are now in effect requiring providers to complete risk assessments at initial visit, each trimester, and postpartum; document all screening results and patient opt-outs; provide prenatal screening education; and coordinate expanded support services (doula, lactation, behavioral health). Prior authorization is now required for basic prenatal, maternal, and preventive services with standard authorization timelines of 5 business days (max 7 calendar days). Failure to comply will result in claim processing delays.
Medium impact
MA11.015ah, Bioengineered Skin Substitutes
Independence Blue Cross·Identified Jul 3, 2026
Failed to analyze policy change
Medium impact
11.08.20at, Bioengineered Skin Substitutes
Independence Blue Cross·Identified Jul 3, 2026
Failed to analyze policy change
High impact
Important Changes to Board-Registered Associates Billing
PacificSource Health Plans·Effective Oct 1, 2026
Effective October 1, 2026, Board-Registered Associates (BRAs) will no longer be eligible to bill for behavioral health services to PacificSource Commercial and Medicare members. Medicaid is not affected. Practices must transition all impacted members to licensed behavioral health providers by the deadline to maintain billable services.
High impact
Provider Enrollment Email Auto Enrollment
Alaska Medicaid·Effective Jun 12, 2026
Alaska Medicaid has implemented an automated email enrollment system with four auto-response triggers for provider enrollment submissions. This policy establishes strict formatting requirements for email subject lines, mandatory attachment inclusion, one-submission-per-email rules, and preferred secure submission methods (DocuSign or mail). Billing teams submitting provider enrollment, revalidation, or update requests to Alaska Medicaid must immediately comply with these naming conventions and submission protocols or risk returned submissions and processing delays.
Medium impact
Information Sheet - Provider Enrollment Update
Alaska Medicaid·Identified Jul 2, 2026
Alaska Medicaid Provider Enrollment is implementing five process enhancements to streamline submissions and reduce processing delays: standardized email subject line naming conventions, auto-reply confirmations for received submissions, new standardized fax/DSM coversheets, Docusign expansion for enrollment revalidation and account updates, and a new portal feature for license uploads. These changes affect how providers submit enrollment, revalidation, and account update documentation to HMS.
Medium impact
ACA Safe Harbor Outage – Scheduled Maintenance
Alabama Medicaid·Effective Jul 7, 2026
ACA Safe Harbor will experience scheduled maintenance on Tuesday, July 7, 2026, from 12:00 a.m. to 5:00 a.m. Central Time, during which real-time and batch 270/271 and 276/277 eligibility and claims status transactions will be unavailable. Provider Web Portal file transmission and claims submission will not be affected. Billing teams should plan workflow around this 5-hour outage window.
High impact
[Georgia] July 2026 Provider Newsletter
Anthem BCBS·Effective Aug 1, 2026
This July 2026 Georgia provider newsletter from Anthem Blue Cross Blue Shield contains multiple policy updates affecting billing, prior authorization, clinical guidelines, and reimbursement across Commercial and Medicare Advantage plans. Key changes include updates to primary diagnosis requirements for inpatient claims, precertification list expansions for specialty pharmacy, clinical criteria updates, and reimbursement policy reminders regarding bundled services and provider preventable conditions.
High impact
[Virginia] July 2026 Provider Newsletter
Anthem BCBS·Identified Jul 2, 2026
This July 2026 Virginia provider newsletter from Anthem Blue Cross Blue Shield contains multiple policy updates affecting billing, prior authorization, pharmacy, and clinical guidelines. Key changes include: (1) Carelon Medical Benefits Management now manages PA reconsiderations with a 10 business day submission window; (2) Primary diagnosis coding requirements for inpatient facility claims effective August 1, 2026; (3) Precertification list changes for specialty pharmacy effective September 1 and October 1, 2026; (4) Service line limits updates for Medicare Advantage; and (5) Member ID card transitions phasing out the suitcase logo requiring continued benefits verification.
High impact
[Ohio] July 2026 Provider Newsletter
Anthem BCBS·Effective Jul 1, 2026
This Ohio newsletter contains multiple policy updates effective July-October 2026 affecting billing, prior authorization, reimbursement, and clinical guidelines across Commercial, Medicare Advantage, and Medicaid plans. Key changes include: (1) Commercial inpatient claims requiring correct primary diagnosis codes effective August 1, 2026; (2) Behavioral health prior authorization requirements for substance use disorder services effective October 1, 2026 for Medicaid; (3) MyCare Ohio home health claims requiring bill type 329 effective June 23, 2026; (4) Carelon clinical appropriateness guidelines and specialty pharmacy precertification list expansions effective September-October 2026; and (5) provider preventable conditions reimbursement policy reminder effective October 1, 2026.
High impact
[New York] July 2026 Provider Newsletter
Anthem BCBS·Effective Aug 1, 2026
This July 2026 New York provider newsletter from Anthem Blue Cross Blue Shield contains multiple policy updates across clinical guidelines, prior authorization requirements, reimbursement policies, and pharmacy precertification effective between August 2026 and January 2027. Key billing team actions include updates to primary diagnosis requirements for Medicare Advantage inpatient claims, facility reimbursement guidelines, prior authorization code changes, and specialty pharmacy precertification expansions.
Medium impact
[California] July 2026 Provider Newsletter
Anthem BCBS·Effective Sep 19, 2026
This is a July 2026 provider newsletter from Anthem Blue Cross summarizing multiple policy updates across administrative, digital, education, and clinical areas. Key changes include: (1) Blue member ID card logo phase-out requiring continued benefit verification; (2) Alerts Hub updates for bulk registration and expanded quality performance alerts; (3) Service line limits updates for Medicare Advantage; (4) Critical Care to Home program effective October 1, 2026 for Medicaid; (5) Clinical criteria and prior authorization requirement updates effective September 19 - October 1, 2026; and (6) Specialty pharmacy precertification list expansions effective September 1 - October 1, 2026.
Low impact
[California] Join our webinars and earn continuing education credits
Anthem BCBS·Effective Jul 1, 2026
Anthem Blue Cross Medi-Cal is offering free continuing education webinars for network providers, coders, billers, and office staff with topics covering documentation, coding quality, denial prevention, and clinical best practices. This is an educational opportunity with no billing or coverage impact—participation is voluntary and designed to improve provider competency.
Medium impact
[California] Improving heart failure outcomes starts with consistent, everyday actions
Anthem BCBS·Effective Jul 1, 2026
Anthem Blue Cross Medicare Advantage (California) issued an educational provider bulletin on heart failure management best practices effective July 1, 2026. This is a clinical guidance document emphasizing guideline-directed medical therapy (GDMT) optimization, post-discharge follow-up within 7 days, and adherence monitoring for both HFrEF and HFpEF patients. While framed as educational with no stated billing impact, it establishes performance metrics that may influence future quality measure tracking and reimbursement incentives.
Medium impact
[California] Updated provider manual is now available
Anthem BCBS·Effective Jul 1, 2026
Anthem Blue Cross has released an updated California Medi-Cal provider manual effective July 1, 2026. The billing team must review the updated manual to identify any changes to billing requirements, coverage policies, prior authorization rules, or documentation standards that may affect claims processing and reimbursement.
Medium impact
[California] Unlock updated pharmacy insights today — visit our provider website
Anthem BCBS·Effective Jul 1, 2026
Anthem Blue Cross (California) is notifying providers to review updated pharmacy information on their provider website. Effective July 1, 2026, commercial and exchange drug lists will be posted quarterly (January, April, July, October). Providers must monitor changes to copay/coinsurance requirements, prior authorization needs, step therapy, therapeutic interchange, and generic substitution procedures to ensure accurate billing and member access.

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2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 111) | PolicyChanges.app

PDS Transition Memo - Second Notice

BT2026111: IHCP discontinues use of JG modifier to indicate 340B drugs on medical claims

BT2026112: IHCP posting FFS payment rates per final rule transparency requirements

BT2026113: IHCP presents status of claim-processing payment for impacted CCBHC claims

BT2026114: IHCP clarifies FQHC and RHC billing procedures for vision services

Hospital Average Commercial Rate (ACR) Data Collection

2026-07-02 - CY 2027 Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Proposed Rule

26-824 Follow New Maternity Care Requirements to Avoid Claim Delays

26-825 Follow New Maternity Care Requirements to Avoid Claim Delays

26-826 Follow New Maternity Care Requirements to Avoid Claim Delays

MA11.015ah, Bioengineered Skin Substitutes

11.08.20at, Bioengineered Skin Substitutes

Important Changes to Board-Registered Associates Billing

Provider Enrollment Email Auto Enrollment

Information Sheet - Provider Enrollment Update

ACA Safe Harbor Outage – Scheduled Maintenance

[Georgia] July 2026 Provider Newsletter

[Virginia] July 2026 Provider Newsletter

[Ohio] July 2026 Provider Newsletter

[New York] July 2026 Provider Newsletter

[California] July 2026 Provider Newsletter

[California] Join our webinars and earn continuing education credits

[California] Improving heart failure outcomes starts with consistent, everyday actions

[California] Updated provider manual is now available

[California] Unlock updated pharmacy insights today — visit our provider website