All Insurance Policy Changes (Page 12)

Continuing from page 11. 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
Facet Joint Interventions for Pain Management
Medicare/CMS - LCD·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
Trigger Point Injections
Medicare/CMS - LCD·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
Trigger Point Injections
Medicare/CMS - LCD·Identified Jul 28, 2026
Failed to analyze policy change
Low impact
Rising health care costs explained – and a clearer path to affordability
Cigna·Identified Jul 28, 2026
This is a Cigna Healthcare newsroom article explaining rising healthcare costs and systemic drivers (chronic disease, hospital consolidation, drug pricing, workforce shortages, and fragmentation) rather than a new billing policy. No specific billing, coding, coverage, or reimbursement changes are announced. This is informational content intended to contextualize healthcare affordability challenges for providers.
Low impact
Boosting immunity and reducing chronic disease through vaccination
Cigna·Identified Jul 28, 2026
This is an informational policy from Cigna Healthcare emphasizing the clinical benefits of routine and seasonal vaccinations for reducing chronic disease risk and complications. The policy references the existing Preventive Care Services (A004) administrative policy for actual vaccine coverage details and directs providers to CDC immunization schedules. No billing code changes, prior authorization modifications, or coverage restrictions are introduced.
Low impact
A holistic approach to pain management
Cigna·Identified Jul 28, 2026
This is an informational policy from Cigna Healthcare promoting a holistic, nonpharmacological approach to chronic pain management. The policy emphasizes multimodal treatment combining medication (NSAIDs) with physical therapy, acupuncture, injections, nerve blocks, massage, and biofeedback, and highlights Cigna's Pathwell Bone & Joint program for musculoskeletal conditions. However, the document contains no specific billing code changes, prior authorization requirements, coverage modifications, or effective implementation dates for the medical billing team.
Low impact
Introducing Pharmacy Forward by Evernorth
Cigna·Identified Jul 28, 2026
Evernorth has launched Pharmacy Forward, an AI-powered specialty pharmacy program through Accredo that aims to improve prescription processing speed, medication adherence, and patient access to specialty therapies. This is an informational announcement about enhanced specialty pharmacy services and capabilities, not a billing or coverage policy change requiring immediate workflow modifications.
Medium impact
Turning grief into purpose: honoring The Cigna Group’s 2026 Volunteer of the Year
Cigna·Identified Jul 28, 2026
Failed to analyze policy change
Low impact
Regence, Central Oregon leaders discuss healthcare’s impact on local economies
Regence BlueCross BlueShield of Oregon·Identified Jul 28, 2026
This is a press release about a panel discussion on healthcare's economic impact in Central Oregon. It does not contain any policy changes, billing code updates, coverage modifications, or operational directives affecting medical billing workflows.
High impact
Attention Nevada Medicaid-enrolled 340B Covered Entities: Nevada Medicaid Fee-For-Service (FFS) Will Integrate the 340B Ceiling Price into the 340B Reimbursement Methodology Beginning October 1, 2026
Nevada Medicaid·Effective Oct 1, 2026
Effective October 1, 2026, Nevada Medicaid Fee-for-Service will integrate the 340B ceiling price into its outpatient drug reimbursement methodology. When the 340B ceiling price (calculated from Average Manufacturer Price and Unit Rebate Amount) is the lowest applicable value in the reimbursement logic, it will be used for reimbursement. Covered entities must submit their 340B Actual Acquisition Cost (AAC) to Nevada Medicaid, and pricing disputes must follow HRSA's 340B Administrative Dispute Resolution process.
High impact
Attention Behavioral Health Outpatient Providers and Provider Type 63 (Psychiatric Residential Treatment Facilities): Reprocessing Efforts
Nevada Medicaid·Effective Jan 1, 2025
Nevada Medicaid is reprocessing claims for behavioral health outpatient providers and psychiatric residential treatment facilities (Provider Type 63) retroactively to January 1, 2025, to apply approved rate increases for pediatric services. A second recycling period for outpatient behavioral health claims will occur shortly, and a single recycle for PRTF facilities will be completed automatically. This is a one-time exception allowing reimbursement at fee schedule rates regardless of usual and customary charges previously billed. Fee-For-Service claims only; MCOs have 60 days to implement rate changes prospectively.
High impact
Attention Provider Type 63 (Psychiatric Residential Treatment Services): Updated Enrollment Requirements
Nevada Medicaid·Effective Jul 28, 2026
Nevada Medicaid has reclassified Psychiatric Residential Treatment Facilities (Provider Type 63) as high-risk providers, effective July 28, 2026. This requires new enrollment documentation including fingerprint background checks, medical director license verification, and shortens revalidation cycles from 5 years to 3 years. PT 63 providers must complete swift revalidation by October 31, 2026.
Low impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for August 2026
Nevada Medicaid·Identified Jul 28, 2026
Nevada Medicaid is announcing optional provider training sessions scheduled for August 2026 covering topics such as prior authorization, enrollment, claims submission, and specialty provider workshops. This is an informational announcement for staff professional development and does not introduce billing, coverage, or reimbursement changes.
High impact
HMS Disallowance and Recoupment Process
South Dakota Medicaid·Effective Aug 1, 2026
South Dakota Medicaid has partnered with Health Management Systems (HMS) to conduct third-party liability and coordination of benefits reviews starting August 2026. Providers must respond to HMS claims review notices within 60 days via their online portal, or claims will be automatically recouped. Failure to register and respond will result in financial recoupment by DSS.
Medium impact
Planned Alabama Medicaid System Maintenance - July 24–26, 2026
Alabama Medicaid·Effective Jul 24, 2026
Alabama Medicaid will conduct planned system maintenance from July 24–26, 2026, affecting multiple online portals and applications. The Eligibility and Claims systems will remain available during this window, but providers should be aware that several portals will be temporarily unavailable, potentially impacting access to estate notices, expedited services, and other administrative functions.
Medium impact
Coverage Update
Alabama Medicaid·Effective Jan 1, 2026
Alabama Medicaid added coverage for 9 audiology procedure codes (CPT 92631-92639, 92641) effective January 1, 2026, covering hearing aid selection, fitting, post-fitting follow-up, and verification services. Coverage is limited to eligible Medicaid beneficiaries ages 0-20 years, and no prior authorization is required.
Medium impact
Reimbursement Policy Updates
BCBS New Mexico·Identified Jul 28, 2026
Blue Cross Blue Shield New Mexico has updated six reimbursement policies affecting preventive services, anesthesia professional billing, hernia repair procedures, pneumatic compression devices, procedure modifiers, and overlapping outpatient/inpatient facility services. The billing team must review each policy individually as they have staggered effective dates between June and October 2026 to ensure accurate claim submission and reimbursement.
Medium impact
Prior Authorization Changes for Some Commercial Members
BCBS New Mexico·Effective Oct 1, 2026
Blue Cross Blue Shield of New Mexico is removing prior authorization requirements for musculoskeletal codes previously reviewed by Carelon and select outpatient services codes previously reviewed by BCBSNM for some commercial members. Simultaneously, Alacura Medical Transportation Management will now handle utilization management review for medical transportation and related services. These changes take effect October 1, 2026.
High impact
Service-Rendered Address Required for Gross Receipts Tax Reimbursement.
BCBS New Mexico·Effective Jan 1, 2026
Effective January 1, 2026, New Mexico providers must include the service-rendered address (where services were actually performed) on all claims submitted for gross receipts tax (GRT) reimbursement under SB 249. This address may differ from the billing address. Failure to populate this field will result in incorrect GRT calculation and reimbursement.
High impact
MA00.030ak, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·Effective Apr 1, 2026
INSUFFICIENT DATA: The policy document title and metadata indicate this is a laboratory services policy update for Medicare Advantage HMO/HMO-POS members (MA00.030ak), effective 04/01/2026. However, the actual policy content detailing specific coverage changes, billing codes, prior authorization requirements, or reimbursement modifications was not provided. The billing team cannot implement changes without access to the full policy text.
Medium impact
MA08.063i, Pertuzumab (Perjeta®) and related biosimilar pertuzumab-dpzb (Poherdy)
Independence Blue Cross·Effective Jul 27, 2026
Medicare Advantage policy MA08.063i updates medical necessity criteria and medical coding requirements for pertuzumab (Perjeta®) and the biosimilar pertuzumab-dpzb (Poherdy®). The billing team must review the specific medical necessity criteria and ensure claims are coded and submitted according to the updated guidance effective immediately.
Medium impact
MA11.008g, Refractive Keratoplasty, Keratoprosthesis, and Corneal Collagen Cross-Linking
Independence Blue Cross·Effective Jul 27, 2026
Policy MA11.008g regarding Refractive Keratoplasty, Keratoprosthesis, and Corneal Collagen Cross-Linking has been updated with changes to General Description, Guidelines, or Informational content. The specific clinical or billing impacts cannot be determined from the provided summary, as the full policy text details are not included in this notification.
Medium impact
MA00.005at, Experimental/Investigational Services
Independence Blue Cross·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
MA08.142f, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
Independence Blue Cross·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
00.03.07as, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·Identified Jul 28, 2026
Failed to analyze policy change

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Archive by year

2023 2024 2025 2026

Facet Joint Interventions for Pain Management

Trigger Point Injections

Trigger Point Injections

Rising health care costs explained – and a clearer path to affordability

Boosting immunity and reducing chronic disease through vaccination

A holistic approach to pain management

Introducing Pharmacy Forward by Evernorth

Turning grief into purpose: honoring The Cigna Group’s 2026 Volunteer of the Year

Regence, Central Oregon leaders discuss healthcare’s impact on local economies

Attention Nevada Medicaid-enrolled 340B Covered Entities: Nevada Medicaid Fee-For-Service (FFS) Will Integrate the 340B Ceiling Price into the 340B Reimbursement Methodology Beginning October 1, 2026

Attention Behavioral Health Outpatient Providers and Provider Type 63 (Psychiatric Residential Treatment Facilities): Reprocessing Efforts

Attention Provider Type 63 (Psychiatric Residential Treatment Services): Updated Enrollment Requirements

Attention All Providers, Delegates and Staff: Upcoming Training Sessions for August 2026

HMS Disallowance and Recoupment Process

Planned Alabama Medicaid System Maintenance - July 24–26, 2026

Coverage Update

Reimbursement Policy Updates

Prior Authorization Changes for Some Commercial Members

Service-Rendered Address Required for Gross Receipts Tax Reimbursement.

MA00.030ak, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

MA08.063i, Pertuzumab (Perjeta®) and related biosimilar pertuzumab-dpzb​ (Poherdy​)

MA11.008g, Refractive Keratoplasty, Keratoprosthesis, and Corneal Collagen Cross-Linking

MA00.005at, Experimental/Investigational Services

MA08.142f, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)

00.03.07as, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

MA08.063i, Pertuzumab (Perjeta®) and related biosimilar pertuzumab-dpzb (Poherdy)