All Insurance Policy Changes (Page 1196)

Continuing from page 1195. 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
04-02-2026 ECM and CS Billing Guide IE LA SAC SD
Molina Healthcare·Effective Apr 2, 2026
Molina Healthcare of California has published a new Enhanced Care Management (ECM) and Community Supports (CS) Billing Guide for Medi-Cal providers. The guide provides billing expectations, HCPCS codes, required modifiers, claims submission guidance, and documentation requirements for ECM and CS services.
Medium impact
04-03-2026 Availity: New Inpatient Continued Stay Request Digital Process IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 3, 2026
Molina Healthcare of California is launching a new digital process through the Availity Provider Portal that allows providers to submit inpatient continued stay requests online instead of using fax or manual submissions. A new Update button will be added to the Authorization Dashboard and Authorization Inquiry details page for extending inpatient authorizations.
Medium impact
04-03-2026 Availity: Reconsiderations IM IE LA OC SAC SD
Molina Healthcare·Identified Jun 19, 2026
Molina Healthcare of California is updating the Availity Provider Portal to streamline appeals and disputes submission. The changes include simplified submission screens, enhanced attachment handling with type selection, and automatic routing to appropriate teams.
Low impact
04-03-2026 Q2 Provider Training Opportunities IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 8, 2026
Molina Healthcare of California announced Q2 2026 training opportunities for network providers across all lines of business. Multiple training sessions are scheduled from April through June 2026 covering regulatory requirements, care management, pediatric care, and new provider orientation.
Low impact
04-07-2026 Provider Bulletin Summary MHC IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 7, 2026
Molina Healthcare of California will now distribute Provider Bulletin summaries every other Tuesday, summarizing all provider communications posted to their website. Providers remain responsible for reviewing full bulletins online for compliance with regulatory requirements and policy changes.
Low impact
04-13-2026 2025 Primary Care Provider Clinical Profile Quality Bonus Program IM IE LA SAC SD
Molina Healthcare·Effective Apr 13, 2026
Molina Healthcare of California has ended its 2025 Primary Care Provider Clinical Profile Quality Bonus Program effective immediately. All program deemers have expired and providers are no longer participating in or eligible for the program, with final incentive payments to be issued during reconciliation.
High impact
04-14-2026 Upcoming Medi-Cal Rx Pharmacy Claim Requirements ICD-10-CM Diagnosis Codes IE LA SAC SD
Molina Healthcare·Identified Jun 19, 2026
Beginning fall 2026, all Medi-Cal Rx pharmacy claims must include ICD-10-CM diagnosis codes or they will be denied. Prescribers must provide diagnosis codes on prescriptions, and pharmacies must include them on all claim submissions including refills.
Medium impact
04-14-2026 Medi-Cal Managed Care Plan Responsibilities for Behavioral Health Data-Sharing APL 26-004 IE LA SAC SD
Molina Healthcare·Effective Apr 1, 2026
Molina Healthcare of California must implement new behavioral health data-sharing requirements for Medi-Cal managed care, including real-time exchange of member information, ADT notifications, and standardized consent forms. Providers must participate in bidirectional data sharing and care coordination with county behavioral health programs.
Low impact
04-14-2026 2026 SUD Care Honor Roll Program IM IE LA OC SAC SD
Molina Healthcare·Identified Jun 19, 2026
Molina Healthcare of California is announcing a voluntary 2026 SUD Care Honor Roll Program for adult acute care hospitals to recognize leadership in substance use disorder care. This is an informational bulletin about a voluntary recognition program, not a billing or coverage change.
Medium impact
04-15-2026 Provider Disputes IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 15, 2026
Molina Healthcare of California issued a reminder about their provider claims dispute process, emphasizing the preferred submission method through the Availity Essentials Portal and clarifying timelines for dispute resolution.
Medium impact
04-16-2026 Interpretation Services for Molina Providers IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 16, 2026
Molina Healthcare of California announces availability of free interpretation services for members through Hanna Interpreting Services, including telephonic, video remote, and in-person interpretation. Providers must notify Molina when canceling or rescheduling interpretation appointments and are encouraged to schedule services early when language assistance is needed.
Medium impact
04-21-2026 Provider Bulletin Summary IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 21, 2026
Molina Healthcare of California will now distribute Provider Bulletin summaries every other Tuesday, consolidating all provider communications posted to their website during each cycle. This bulletin contains several important updates including the end of quality bonus programs, new Medi-Cal pharmacy claim requirements for ICD-10-CM codes starting Fall 2026, and reminders about available services.
Medium impact
04-24-2026 2026 Risk Adjustment & Health and Human Services Risk Adjustment Data Validation Data Collection IM IE LA OC SAC SD
Molina Healthcare·Effective Apr 27, 2026
Molina Healthcare of California is conducting their 2026 Risk Adjustment and HHS-RADV data collection starting April 27, 2026. Providers must prepare and submit medical records for specified members through secure email or coordinate site visits for record access.
Medium impact
05-05-2026 Billing Reminder: Skilled Nursing Facilities, ICF-DD and Subacute Care Facilities IM IE LA SAC SD
Molina Healthcare·Effective May 5, 2026
Molina Healthcare of California issued billing guidance for Skilled Nursing Facilities, ICF-DD, and Subacute Care Facilities to reduce claim denials. The bulletin identifies four common denial reasons: duplicate service billing, missing authorization, enrollment discrepancies, and invalid revenue codes, with specific recommendations to prevent each type of denial.
High impact
05-06-2026 Use of Molina Contracted Laboratories IM IE LA OC SAC SD
Molina Healthcare·Effective May 6, 2026
Molina Healthcare of California requires all network providers to use only Quest Diagnostics and LabCorp for laboratory services for Molina members. Using non-contracted labs without authorization may result in claim denials or provider financial responsibility.
High impact
05-11-2026 Immediate Compliance Required Artificial Intelligence (AI) Use Restrictions IM IE LA OC SAC SD
Molina Healthcare·Effective May 11, 2026
Molina Healthcare of California has implemented immediate restrictions on AI use, prohibiting AI-generated voice technology for all communications with Molina and requiring clinician review for any AI decisions affecting patient care. Providers must immediately cease AI voice communications and implement controls to prevent violations.
High impact
05-12-2026 Quality Measures for Encounter Data Update: Quality Measures for Encounter Data 2.0 – APL 26-003 IE LA SAC SD
Molina Healthcare·Effective Jan 1, 2026
Molina Healthcare of California has implemented new Quality Measures for Encounter Data 2.0 requirements for Medi-Cal providers, effective January 1, 2026. Providers must ensure encounter data submissions meet strict performance thresholds including 120-day submission deadlines, duplicate encounter limits, and denial correction requirements to avoid financial sanctions starting July 1, 2027.
Medium impact
05-13-2026 Reminder to Provide Alcohol and Drug Use Screening, Assessment, Brief Interventions and Referrals to Treatment IE LA SAC SD
Molina Healthcare·Identified Jun 19, 2026
Molina Healthcare of California is reminding providers to implement alcohol and drug use screening, assessment, brief interventions, and referrals to treatment (SABIRT) for Medi-Cal members ages 11 and older. This is an ongoing requirement with specific billing codes and frequency limits that must be followed.
Medium impact
05-13-2026 CORRECTION: 2026 Medicaid Pay-For-Performance/HEDIS Performance Bonus Program IE LA SAC SD
Molina Healthcare·Effective Jan 1, 2026
Molina Healthcare corrected their 2026 Medicaid Pay-For-Performance program, removing the 200-member minimum panel requirement for Cervical Cancer Screening bonuses and requiring all participants to sign new agreements and enroll in electronic payments to receive performance bonuses.
Medium impact
05-14-2026 Changes to Recuperative Care (RC) & Short-Term Post-Hospitalization (STPH) Referrals New Required Form IE LA SAC SD
Molina Healthcare·Effective May 14, 2026
Molina Healthcare of California has updated the required referral forms for Recuperative Care (RC) and Short-Term Post-Hospitalization (STPH) services. All new and ongoing referral submissions must use the new forms which include updated fields, clearer designations, and confirmation requirements to improve processing accuracy.
Medium impact
05-18-2026 Provider Roster Submission Requirements and Common Rejection Reasons IM IE LA OC SAC SD
Molina Healthcare·Effective May 18, 2026
Molina Healthcare of California and Central Health Medicare Plan updated their provider roster submission requirements, implementing a new policy where entire roster submissions will be rejected if any errors are found. The bulletin identifies common rejection reasons including missing physician service location county, primary specialty taxonomy, and supervising physician information for nurse practitioners.
Medium impact
05-19-2026 Provider Bulletin Summary IM IE LA OC SAC SD
Molina Healthcare·Effective May 19, 2026
Molina Healthcare of California will now distribute Provider Bulletin summaries every other Tuesday, consolidating all provider communications posted during each cycle. This bulletin summarizes 6 policy updates from May 6-15, 2026, including lab usage requirements, AI restrictions, and quality measure updates.
Medium impact
05-26-2026 Informational Bulletin Regarding Emergency Declaration – Orange County Chemical Incident OC
Molina Healthcare·Effective May 23, 2026
Molina Healthcare issued an emergency notification regarding a chemical incident in Orange County that has resulted in large-scale evacuations. The insurer is prioritizing member safety and asking providers to contact their support line if they encounter challenges providing care to members in the affected area.
High impact
05-28-2026 Required Surgical Modifiers IE LA SAC SD
Molina Healthcare·Effective Sep 1, 2026
Molina Healthcare of California now requires appropriate modifiers on all surgical procedure codes for Medi-Cal claims. Claims submitted without required modifiers will be returned to providers for correction starting September 1, 2026.
High impact
05-29-2026 Maternity Services for Pregnant and Postpartum Medi-Cal Members APL 26-005 IE LA SAC SD
Molina Healthcare·Effective May 29, 2026
Molina Healthcare has issued comprehensive new requirements for maternity care for Medi-Cal members, establishing standardized protocols for risk assessments, care coordination, and expanded services including doula care, lactation support, and behavioral health screening throughout pregnancy and 12 months postpartum. This policy consolidates and supersedes multiple previous guidelines, requiring providers to ensure coordinated care across multiple specialties and document all assessments and referrals.

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Archive by year

2023 2024 2025 2026

04-02-2026 ECM and CS Billing Guide IE LA SAC SD

04-03-2026 Availity: New Inpatient Continued Stay Request Digital Process IM IE LA OC SAC SD

04-03-2026 Availity: Reconsiderations IM IE LA OC SAC SD

04-03-2026 Q2 Provider Training Opportunities IM IE LA OC SAC SD

04-07-2026 Provider Bulletin Summary MHC IM IE LA OC SAC SD

04-13-2026 2025 Primary Care Provider Clinical Profile Quality Bonus Program IM IE LA SAC SD

04-14-2026 Upcoming Medi-Cal Rx Pharmacy Claim Requirements ICD-10-CM Diagnosis Codes IE LA SAC SD

04-14-2026 Medi-Cal Managed Care Plan Responsibilities for Behavioral Health Data-Sharing APL 26-004 IE LA SAC SD

04-14-2026 2026 SUD Care Honor Roll Program IM IE LA OC SAC SD

04-15-2026 Provider Disputes IM IE LA OC SAC SD

04-16-2026 Interpretation Services for Molina Providers IM IE LA OC SAC SD

04-21-2026 Provider Bulletin Summary IM IE LA OC SAC SD

04-24-2026 2026 Risk Adjustment & Health and Human Services Risk Adjustment Data Validation Data Collection IM IE LA OC SAC SD

05-05-2026 Billing Reminder: Skilled Nursing Facilities, ICF-DD and Subacute Care Facilities IM IE LA SAC SD

05-06-2026 Use of Molina Contracted Laboratories IM IE LA OC SAC SD

05-11-2026 Immediate Compliance Required Artificial Intelligence (AI) Use Restrictions IM IE LA OC SAC SD

05-12-2026 Quality Measures for Encounter Data Update: Quality Measures for Encounter Data 2.0 – APL 26-003 IE LA SAC SD

05-13-2026 Reminder to Provide Alcohol and Drug Use Screening, Assessment, Brief Interventions and Referrals to Treatment IE LA SAC SD

05-13-2026 CORRECTION: 2026 Medicaid Pay-For-Performance/HEDIS Performance Bonus Program IE LA SAC SD

05-14-2026 Changes to Recuperative Care (RC) & Short-Term Post-Hospitalization (STPH) Referrals New Required Form IE LA SAC SD

05-18-2026 Provider Roster Submission Requirements and Common Rejection Reasons IM IE LA OC SAC SD

05-19-2026 Provider Bulletin Summary IM IE LA OC SAC SD

05-26-2026 Informational Bulletin Regarding Emergency Declaration – Orange County Chemical Incident OC

05-28-2026 Required Surgical Modifiers IE LA SAC SD

05-29-2026 Maternity Services for Pregnant and Postpartum Medi-Cal Members APL 26-005 IE LA SAC SD