All Insurance Policy Changes (Page 1220)

Continuing from page 1219. 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
ClaimsXtenTM Code Update Effective March 16, 2026
BCBS Montana·Effective Mar 16, 2026
Blue Cross Blue Shield of Montana will implement updates to their ClaimsXten code auditing tool on March 16, 2026, which may include additions, deletions, and revisions to CPT and HCPCS codes. Providers should use the Clear Claim Connection tool to check how coding combinations will be processed under the updated system.
Medium impact
Avoid the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
BCBS Montana·Effective Jan 14, 2026
Blue Cross Blue Shield of Montana issued guidance discouraging inappropriate use of antipsychotic medications for anxiety disorders, as most antipsychotics are not FDA-approved for anxiety conditions like panic disorder and generalized anxiety disorder. The policy emphasizes evidence-based prescribing and references clinical practice guidelines for proper anxiety disorder treatment.
Medium impact
Call for Preservice Requests for Applied Behavior Analysis for Commercial Members
BCBS Montana·Effective Apr 1, 2026
Starting April 2026, Applied Behavior Analysis (ABA) preservice requests for commercial members must be submitted by phone call instead of forms. Customer service representatives will guide the intake process and a clinician will follow up for telephonic review.
Low impact
Look for Your Medicare Advantage Access and Availability Survey
BCBS Montana·Effective Feb 15, 2026
Blue Cross Blue Shield Montana will conduct a biannual Medicare Advantage access and availability survey in mid-February 2026, contacting a random sample of providers to complete a brief three-question survey about appointment wait times. This is a CMS requirement to ensure network accessibility for Medicare Advantage members.
Low impact
Quality Measures Help Track Our Members’ Heart Health
BCBS Montana·Effective Jan 23, 2026
This policy provides informational guidance on heart health quality measures that the insurance company tracks for members, including blood pressure control and statin therapy compliance. It offers tips for providers to improve documentation and care coordination but does not introduce new billing requirements or coverage changes.
Low impact
Encourage Medicare Advantage Members to Respond to Survey on Health Care Experiences
BCBS Montana·Effective Mar 1, 2026
Blue Cross and Blue Shield of Montana is encouraging providers to help Medicare Advantage members respond to the annual CAHPS survey that begins in March, which measures patient experiences and affects CMS Star Ratings. Providers should focus on improving access to care, communication, and preventive care to support positive member experiences.
Medium impact
Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization
BCBS Montana·Effective Jan 1, 2026
Starting Jan 1, 2026, Blue Cross Blue Shield of Montana will require enhanced prior authorization for certain medical benefit drugs that have therapeutic equivalents or alternatives. When submitting prior auth requests, providers will receive a list of preferred drugs that are clinically appropriate and more cost-effective alternatives.
Medium impact
Coding and Compensation Policy Updates
BCBS Montana·Effective Jan 1, 2026
Blue Cross Blue Shield of Montana updated multiple coding and compensation policies including Drug Testing, Robotic Assisted Surgery, Telehealth services, and Applied Behavioral Analysis. These policies contain updated payment rules and methodologies for CPT, HCPCS, and ICD-10 coding with varying effective dates from January 1 to March 20, 2026.
High impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Montana·Effective Apr 1, 2026
Blue Cross Blue Shield of Montana is implementing prior authorization changes across multiple plan types with different effective dates. Key changes include adding medical transportation and advanced imaging codes for commercial members, miscellaneous codes for Medicare Advantage, and several code additions/removals for Healthy Montana Kids members.
Medium impact
Medical Transportation Changes, Effective April 1, 2026
BCBS Montana·Effective Apr 1, 2026
Effective April 1, 2026, Alacura Medical Transportation Management will take over managing prior authorization, clinical review, and retrospective claim review for all commercial ground and air medical transportation services. Facilities and ambulance providers must contact Alacura before non-emergent transports to ensure proper authorization.
Medium impact
Discuss Colon Health and Preventive Screening with Our Members
BCBS Montana·Effective Feb 5, 2026
Blue Cross Blue Shield of Montana issued guidance encouraging providers to discuss colon health and preventive screening with members ages 45-75. The policy outlines various screening options (FIT, colonoscopy, Cologuard, etc.) and emphasizes proper documentation for HEDIS measure compliance and closing care gaps.
Medium impact
Encourage Follow-up Care after Hospital Visits for Mental Health
BCBS Montana·Effective Feb 6, 2026
Blue Cross Blue Shield Montana is encouraging providers to schedule mental health follow-up visits within 7-30 days after hospital or emergency department visits for mental illness. This policy focuses on improving HEDIS quality measures for mental health care coordination and does not change billing requirements, but emphasizes proper documentation and care coordination.
Medium impact
GeoBlue® Is Now Blue Cross Blue Shield Global Solutions℠
BCBS Montana·Effective Feb 18, 2026
GeoBlue international health insurance has been rebranded to Blue Cross Blue Shield Global Solutions, with a phased transition through end of 2027. Members may present either GeoBlue or BCBS Global Solutions ID cards during the transition period, but coverage and benefits remain unchanged.
Medium impact
Verify Your Directory Information Every 90 Days
BCBS Montana·Effective Feb 19, 2026
Blue Cross Blue Shield of Montana now requires all providers to verify their directory information every 90 days through Availity Essentials or a Demographic Change Form, even if no information has changed. This is a federal requirement to ensure accurate provider directory data for members and other providers.
High impact
Reimbursement Policy Updates
BCBS Montana·Effective Jan 1, 2026
Blue Cross Blue Shield of Montana updated 22 reimbursement policies affecting laboratory testing, behavioral health services, telehealth, and surgical procedures. These updates include changes to compensation rules for various diagnostic tests, Applied Behavioral Analysis for autism, telehealth services, and assistant surgery procedures with effective dates ranging from January 1 to May 20, 2026.
Medium impact
Prior Authorization Changes for Some Commercial and Government Program Members, Effective April 1, 2026
BCBS Montana·Effective Apr 1, 2026
Blue Cross Blue Shield of Montana is updating prior authorization requirements effective April 1, 2026. For commercial members, psychological/neuropsychological testing codes will no longer require prior auth through BCBSMT. For Medicare Advantage members, revascularization codes will be transferred to different review entities.
Medium impact
See How to Request Help on Certain BlueCard® Claims
BCBS Montana·Effective Mar 2, 2026
Blue Cross Blue Shield of Montana has established a new BlueCard Executive escalation process for high-value, aged claims. Providers who are members of the Provider Multidistrict Litigation Settlement Class can now escalate specific BlueCard claims that meet dollar amount and aging criteria directly to a senior-level executive for resolution.
Low impact
Quality Measures Track Treatment and Follow-Up Visits for Substance Use Disorders
BCBS Montana·Effective Mar 4, 2026
Blue Cross Blue Shield Montana updated their HEDIS quality measure tracking for substance use disorder treatment and follow-up visits. This is primarily informational guidance for providers on how the insurer monitors care quality, including timelines for treatment initiation, follow-up visits, and pharmacotherapy duration.
Medium impact
Providers with Unused Record IDs May Be Terminated from Networks
BCBS Montana·Effective Mar 5, 2026
Blue Cross and Blue Shield of Montana will terminate providers from networks if they don't file claims using their NPI and TIN within 24 months. Terminated providers will receive 90-day notice via certified letter and can contact the insurer to cancel termination.
Medium impact
Access Resource on 2026 Quality Measures in Availity® Essentials
BCBS Montana·Effective Mar 11, 2026
Blue Cross Blue Shield of Montana has released a new 2026 Quality Care resource in Availity Essentials containing HEDIS coding guidance for quality measures. The resource includes CPT, HCPCS, and ICD-10 codes for behavioral health, cancer screenings, diabetes care, immunizations, and other preventive services to help providers document care gaps accurately.
High impact
Claim Editing Changes for Evaluation and Management Services for Commercial Members, Effective July 1, 2026
BCBS Montana·Effective Jul 1, 2026
Effective July 1, 2026, Blue Cross Blue Shield of Montana will implement enhanced claim editing for evaluation and management (E&M) services on commercial plans. Claims will be automatically reviewed against AMA guidelines, and if the documentation doesn't support the billed E&M level, reimbursement will be reduced to the validated lower level of service.
Medium impact
Reimbursement Policy Updates
BCBS Montana·Effective Apr 1, 2026
Blue Cross Blue Shield of Montana updated their reimbursement policy CPCPLAB044 for Lyme Disease Testing, which will affect payment rules and methodologies for related laboratory procedures. This policy change becomes effective April 1, 2026 and may impact how Lyme disease testing claims are processed and reimbursed.
Medium impact
Use Updated Medicare Outpatient Observation Notice
BCBS Montana·Effective Apr 20, 2026
The Centers for Medicare & Medicaid Services has updated the Medicare Outpatient Observation Notice that hospitals must provide to Medicare Advantage members under observation for more than 24 hours. Providers must transition to using the new CMS notice by April 20, 2026, and the updated version is effective through February 28, 2029.
High impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Montana·Effective Apr 1, 2026
Blue Cross Blue Shield of Montana is implementing significant prior authorization changes for commercial and government program members, with different review vendors handling various service categories. Commercial members will see changes starting April 1, 2026 (medical oncology code replacements) and July 1, 2026 (addition of radiation oncology, advanced imaging, molecular genetic lab, and drug codes), while Medicare Advantage members will have new Part B Step Therapy and various code additions effective July 1, 2026.
Low impact
Earn Continuing Education Credit: Webinar on Youth Behavioral Health
BCBS Montana·Identified Jun 18, 2026
Blue Cross Blue Shield Montana is offering a free continuing education webinar on youth behavioral health scheduled for May 11 and 13, 2026, providing 1.0 CME/CEU credit at no cost. This is an educational opportunity rather than a policy change affecting billing operations.

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Archive by year

2023 2024 2025 2026

ClaimsXtenTM Code Update Effective March 16, 2026

Avoid the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders

Call for Preservice Requests for Applied Behavior Analysis for Commercial Members

Look for Your Medicare Advantage Access and Availability Survey

Quality Measures Help Track Our Members’ Heart Health

Encourage Medicare Advantage Members to Respond to Survey on Health Care Experiences

Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization

Coding and Compensation Policy Updates

Prior Authorization Changes for Some Commercial and Government Program Members

Medical Transportation Changes, Effective April 1, 2026

Discuss Colon Health and Preventive Screening with Our Members

Encourage Follow-up Care after Hospital Visits for Mental Health

GeoBlue® Is Now Blue Cross Blue Shield Global Solutions℠

Verify Your Directory Information Every 90 Days

Reimbursement Policy Updates

Prior Authorization Changes for Some Commercial and Government Program Members, Effective April 1, 2026

See How to Request Help on Certain BlueCard® Claims

Quality Measures Track Treatment and Follow-Up Visits for Substance Use Disorders

Providers with Unused Record IDs May Be Terminated from Networks

Access Resource on 2026 Quality Measures in Availity® Essentials

Claim Editing Changes for Evaluation and Management Services for Commercial Members, Effective July 1, 2026

Reimbursement Policy Updates

Use Updated Medicare Outpatient Observation Notice

Prior Authorization Changes for Some Commercial and Government Program Members

Earn Continuing Education Credit: Webinar on Youth Behavioral Health