All Insurance Policy Changes (Page 1222)

Continuing from page 1221. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
Provider Rights and Responsibilities
BCBS Montana·Effective Jun 11, 2026
This policy outlines provider rights and responsibilities for credentialing, case management programs, and utilization management decisions. It clarifies that licensed clinical personnel make all utilization management decisions based on medical necessity and coverage, not financial incentives.
Low impact
Encourage Medicare Members to Respond to Health Outcomes Survey
BCBS Montana·Identified Jun 18, 2026
CMS sends annual Health Outcomes Survey to Medicare members from mid-July through early November asking them to rate their care. Providers should encourage members to respond when asked and consider discussing survey topics throughout the year as results affect CMS Five-Star Quality ratings.
High impact
Alacura for Medical Transportation Management: Learn More
BCBS Montana·Effective Apr 1, 2026
Effective April 1, 2026, Blue Cross Blue Shield of Montana implemented Alacura Medical Transportation Management to conduct prior authorization and medical necessity reviews for air and ground ambulance services for fully insured and retail PPO, POS, and HMO members. Providers must contact Alacura at 866-307-1303 before all nonemergent and nonurgent medical transports, and ambulance providers should verify Alacura engagement before patient pickup.
Medium impact
Encourage Our Members To Complete a Depression Screening
BCBS Montana·Effective Jun 16, 2026
Blue Cross Blue Shield Montana is encouraging providers to screen members ages 12 and older for depression using standardized tools like PHQ-9. Providers should report screening results using codes G8431 (positive screen with plan) or G8510 (negative screen) for informational purposes only, not reimbursement.
Medium impact
Email or Fax Documentation for Blue Distinction® Centers for Transplant
BCBS Montana·Effective Jun 17, 2026
Blue Cross Blue Shield of Montana has retired their mail-in address for Blue Distinction Centers for Transplant documentation. All transplant center documentation must now be submitted via email or fax to 312-233-4222 instead of by mail.
Low impact
Maternal Health Webinars: Earn Continuing Education Credit
BCBS Montana·Effective Jun 18, 2026
Blue Cross Blue Shield of Montana is offering two free maternal health continuing education webinars through the Morehouse School of Medicine Center for Maternal Health Equity. Each course provides 1.0 AMA PRA Category 1 CME credit and covers respectful maternity care and non-medical health drivers in perinatal care.
High impact
ForwardHealth Update 2025-26: ForwardHealth Vaccine Coverage: New Sources of Vaccine Recommendations and Revised Billing for COVID-19, Influenza, and Measles, Mumps, Rubella, and Varicella VaccinesDecember 2, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 3.
Wisconsin ForwardHealth·Effective Nov 1, 2025
ForwardHealth (Wisconsin Medicaid) is expanding vaccine coverage beyond CDC recommendations and implementing new billing processes for COVID-19, influenza, and MMRV vaccines effective November 1, 2025. Claims for these vaccines submitted October 1-31 will be suspended and automatically processed November 1.
Medium impact
ForwardHealth Update 2025-27: Prior Authorization Changes for Certain Preferred Drug List Classes, Anti-Obesity Drugs, and Other Pharmacy Policy Effective November 1, 2025
Wisconsin ForwardHealth·Effective Nov 1, 2025
ForwardHealth (Wisconsin Medicaid) is implementing new prior authorization requirements for several drug classes effective November 1, 2025, including Alzheimer's agents (Leqembi IQLIK), bone resorption drugs (Bonsity and teriparatide), oral glucocorticoids (Jaythari and Pyquvi), and anti-obesity medications. These changes require specific clinical documentation and PA forms to be submitted through pharmacies.
Medium impact
ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth (Wisconsin Medicaid/BadgerCare Plus) has increased reimbursement rates for multiple service categories including dental anesthesia, home health visits, obstetrics, personal care, private duty nursing, narcotic treatment, and residential substance abuse treatment services. The updated fee schedules will be available on the ForwardHealth Portal.
High impact
ForwardHealth Update 2025-29: Severe Malocclusion Policy Clarification
Wisconsin ForwardHealth·Effective Oct 31, 2025
ForwardHealth is replacing the Salzmann Index scoring system with new orthodontic automatic qualifiers (AQs) to determine medically necessary orthodontic care for severe malocclusions. The new criteria include specific conditions like cleft palate, severe overjet, crossbites, and skeletal malocclusions that automatically qualify for coverage.
Low impact
ForwardHealth Update 2025-30: Dental Therapists May Enroll With Wisconsin Medicaid and Bill as Separate ProvidersDecember 16, 2025: This Update has been revised since its original publication. Information about restorative services dental therapists may provide has been clarified. See page 7 of the Update for more information.
Wisconsin ForwardHealth·Effective Jan 1, 2026
Beginning January 1, 2026, dental therapists can now enroll separately with Wisconsin Medicaid to provide and bill for preventive, restorative, and periodontal dental services. This creates a new provider category that can submit independent claims for covered dental services.
Medium impact
ForwardHealth Update 2025-31: ForwardHealth Holiday Schedule
Wisconsin ForwardHealth·Effective Nov 27, 2025
ForwardHealth (Wisconsin Medicaid programs) has updated their holiday schedule for 2025-2026, specifying when offices are closed and how holidays affect claim submission deadlines and payment processing. Claims must still meet weekly processing deadlines, and payment delays of one day will occur depending on which day of the week holidays fall.
Medium impact
ForwardHealth Update 2025-32: 2025 Hospice Reimbursement Rate Changes
Wisconsin ForwardHealth·Effective Oct 1, 2025
ForwardHealth updated Wisconsin Medicaid and BadgerCare Plus hospice reimbursement rates effective October 1, 2025, with county-specific rates for routine care, continuous care, inpatient respite, and general inpatient services. ForwardHealth will automatically adjust previously paid claims for services provided on and after the effective date.
Medium impact
ForwardHealth Update 2025-33: ForwardHealth Enhances Behavioral Health Treatment With More Options for Continuing Care and Concurrent Services
Wisconsin ForwardHealth·Effective Dec 1, 2025
ForwardHealth (Wisconsin Medicaid) expands behavioral health treatment options effective December 1, 2025, adding continuing care coverage for discharged SUD patients and allowing concurrent outpatient mental health services with residential SUD treatment. A new U2 modifier is required for billing continuing care services.
High impact
ForwardHealth Update 2025-34: Prescribing, Referring, and Ordering Permissions UpdatedDecember 15, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 1.
Wisconsin ForwardHealth·Effective Dec 1, 2025
Effective December 1, 2025, any Medicaid-enrolled provider acting within their scope of practice may now prescribe, refer, and order medical services and drugs - previously only physicians could do this. This significantly expands prescribing and ordering authority to nurse practitioners, physician assistants, therapists, and other qualified providers for Wisconsin Medicaid and BadgerCare Plus programs.
High impact
ForwardHealth Update 2025-35: Prior Authorization Process Improvements: Overview
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth is implementing prior authorization process improvements for Wisconsin Medicaid and BadgerCare Plus in two phases: January 1, 2026 brings new urgent PA identification requirements, clearer denial messages, new PA status categories, and a revised fax cover sheet; January 1, 2027 establishes mandatory processing timeframes of 72 hours for urgent and 7 days for non-urgent requests.
Medium impact
ForwardHealth Update 2025-36: January 2026 Preferred Drug List Changes and Other Pharmacy PolicyJanuary 6, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 10, 29, and 33-34.
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth (Wisconsin Medicaid) updated their Preferred Drug List effective January 1, 2026, adding new drug classes and changing prior authorization requirements for multiple medications. Two new antibiotics (Blujepa and Orlynvah) now require clinical prior authorization with specific criteria for female patients with uncomplicated UTIs.
Medium impact
ForwardHealth Update 2025-37: Changes for Casgevy and Lyfgenia and Other Polices in the New Cell and Gene Therapy Access Model for Members With Sickle Cell Disease
Wisconsin ForwardHealth·Effective Jan 1, 2026
Wisconsin ForwardHealth (BadgerCare Plus/Medicaid) is implementing the Cell and Gene Therapy Access Model for sickle cell disease treatments Casgevy and Lyfgenia, with revised clinical criteria and prior authorization requirements. Members participating in the model will be permanently exempted from HMO enrollment requirements.
High impact
ForwardHealth Update 2025-38: Prior Authorization Process Improvements: Removing Spell of Illness and Revising Limits for Therapy ServicesFebruary 9, 2026: This Update has been revised since its original publication. Audiologists will now receive the ForwardHealth Update, two ForwardHealth Online Handbook topics were added to the Quick Links section, and information about Individualized Education Plan (IEP) submissions was added. Revised information appears in red text on pages 1 and 2.
Wisconsin ForwardHealth·Effective Jan 1, 2026
Effective January 1, 2026, ForwardHealth is discontinuing the spell of illness policy for PT, OT, and SLP services and changing from a lifetime limit to an annual limit of 35 visits per discipline before prior authorization is required. Providers must use new process types and updated forms for all prior authorization requests.
High impact
ForwardHealth Update 2025-39: New Per Diem Crisis Stabilization Service Tiers and Billing Modifiers
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth is implementing a new 3-tier reimbursement structure for crisis stabilization services with increased per diem rates and new billing modifiers. Hourly billing is limited to 8 hours per date of service, after which providers must use per diem billing with appropriate tier-specific modifiers.
Low impact
ForwardHealth Update 2025-40: Expanding Tribal Federally Qualified Health Center Shared Savings
Wisconsin ForwardHealth·Identified Jun 18, 2026
ForwardHealth is implementing a new Tribal Shared Savings program that allows outside providers with signed care coordination agreements with Tribal FQHCs to receive 100% Federal Medical Assistance Percentage (FMAP) for services to Native American/Alaska Native Medicaid members. Providers must include the Tribal FQHC's National Provider Identifier or Medicaid Provider ID in the Referring Provider or Referral Number fields when submitting claims.
Medium impact
ForwardHealth Update 2025-41: Behavioral Treatment Benefit Policy Clarifications and ForwardHealth Online Handbook Revisions
Wisconsin ForwardHealth·Identified Jun 18, 2026
ForwardHealth has updated behavioral treatment benefit policies for Wisconsin Medicaid and BadgerCare Plus following a federal audit. Changes include new documentation requirements, clarified non-covered services, and new topics for adaptive behavior treatment protocols and concurrent billing.
Low impact
ForwardHealth Update 2025-42: Reimbursement Increase for Nurse Aide Training and Testing
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth (Wisconsin Medicaid) is significantly increasing reimbursement rates for certified nursing assistant (CNA) training and testing costs effective January 1, 2026. Training reimbursement increases from $225 to $700, and competency testing increases from $61.50 to $135.
High impact
ForwardHealth Update 2026-01: ForwardHealth Expands Vaccine Billing Process Changes
Wisconsin ForwardHealth·Effective Feb 1, 2026
ForwardHealth is expanding vaccine billing requirements effective February 1, 2026. All providers must now include both vaccine product codes AND administration codes on all vaccine claims, and must add the SL modifier for vaccines supplied through the federal Vaccines for Children (VFC) Program.
Low impact
ForwardHealth Update 2026-02: Tribal Federally Qualified Health Centers Can Bill Pharmacy Visits as Encounters
Wisconsin ForwardHealth·Effective Jan 1, 2026
Effective January 1, 2026, Tribal Federally Qualified Health Centers (FQHCs) in Wisconsin can now bill pharmacy visits as encounters under their All-Inclusive Rate (AIR) reimbursement option. This new policy allows Tribal FQHCs to receive encounter payments for covered outpatient drugs dispensed by their pharmacies, addressing ingredient costs previously excluded from FQHC encounter payments.

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Archive by year

2023 2024 2025 2026

Provider Rights and Responsibilities

Encourage Medicare Members to Respond to Health Outcomes Survey

Alacura for Medical Transportation Management: Learn More

Encourage Our Members To Complete a Depression Screening

Email or Fax Documentation for Blue Distinction® Centers for Transplant

Maternal Health Webinars: Earn Continuing Education Credit

ForwardHealth Update 2025-27: Prior Authorization Changes for Certain Preferred Drug List Classes, Anti-Obesity Drugs, and Other Pharmacy Policy Effective November 1, 2025

ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases

ForwardHealth Update 2025-29: Severe Malocclusion Policy Clarification

ForwardHealth Update 2025-31: ForwardHealth Holiday Schedule

ForwardHealth Update 2025-32: 2025 Hospice Reimbursement Rate Changes

ForwardHealth Update 2025-33: ForwardHealth Enhances Behavioral Health Treatment With More Options for Continuing Care and Concurrent Services

ForwardHealth Update 2025-34: Prescribing, Referring, and Ordering Permissions UpdatedDecember 15, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 1.

ForwardHealth Update 2025-35: Prior Authorization Process Improvements: Overview

ForwardHealth Update 2025-36: January 2026 Preferred Drug List Changes and Other Pharmacy PolicyJanuary 6, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 10, 29, and 33-34.

ForwardHealth Update 2025-37: Changes for Casgevy and Lyfgenia and Other Polices in the New Cell and Gene Therapy Access Model for Members With Sickle Cell Disease

ForwardHealth Update 2025-39: New Per Diem Crisis Stabilization Service Tiers and Billing Modifiers

ForwardHealth Update 2025-40: Expanding Tribal Federally Qualified Health Center Shared Savings

ForwardHealth Update 2025-41: Behavioral Treatment Benefit Policy Clarifications and ForwardHealth Online Handbook Revisions

ForwardHealth Update 2025-42: Reimbursement Increase for Nurse Aide Training and Testing

ForwardHealth Update 2026-01: ForwardHealth Expands Vaccine Billing Process Changes

ForwardHealth Update 2026-02: Tribal Federally Qualified Health Centers Can Bill Pharmacy Visits as Encounters