All Insurance Policy Changes (Page 1293)

Continuing from page 1292. 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
R242SOMA: Revisions to the State Operations Manual (SOM) Chapter 9 Exhibits.
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace (Healthcare.gov). It includes help desk phone numbers, email addresses, hours of operation, and useful websites for marketplace registration and training.
Low impact
R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This appears to be a mislabeled document - the title references IOM updates and National Coverage Determinations for January 2026, but the content is actually an agent/broker help desk contact directory for the Federally-facilitated Marketplace from May 2024. No actual policy changes for medical billing are present in this document.
Low impact
R13816OTN: Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange(EDI) Front End Updates for October 2026
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and help desk resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It outlines various support channels for registration, training, enrollment assistance, and technical issues related to marketplace operations.
Low impact
R13818OTN: Implementation of Editing for Programs of All-Inclusive Care for the Elderly (PACE) Inpatient Claims Submitted for Indirect Medical Education (IME) Payment
Medicare/CMS - Transmittals·Identified Jun 16, 2026
There appears to be a mismatch between the policy title (PACE Inpatient Claims IME Payment editing) and the actual content (Agent/Broker Marketplace Help Desk contact information). The provided content is administrative guidance for insurance agents and brokers working with the Federally-facilitated Marketplace, not billing policy changes.
Low impact
R13821PI: Updates of Chapters 3, 4, and Exhibits in Publication (Pub.) 100-08, Including Updates to the Provider Notification Process and Vetting with the CMS Process
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides a comprehensive directory of CMS help desk contacts and resources for agents and brokers working with the Federally-facilitated Marketplace. It includes updated contact information, hours of operation, and available websites for marketplace registration, training, and consumer assistance.
Low impact
R13822CP: Quarterly Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and resources for agents and brokers working with the Health Insurance Marketplace (FFM). It contains help desk contact numbers, email addresses, and useful websites for marketplace registration, training, and consumer assistance.
Low impact
R13825FM: Updates to the Internet Only Manual, Publication 100-06, Chapter 3, Overpayments, Section 140-140.8.4 - Bankruptcy
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It contains help desk phone numbers, email addresses, hours of operation, and useful websites for marketplace registration and training. This is not a policy change affecting medical billing operations.
Low impact
R13826CP: Medicare Beneficiary Date of Death - Manual Update
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and help desk resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes phone numbers, email addresses, hours of operation, and website resources for various marketplace-related inquiries and support services.
Low impact
R243SOMA: Revisions to State Operations Manual (SOM), Chapter 5
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides a comprehensive directory of CMS help desks and contact information for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes phone numbers, email addresses, hours of operation, and useful websites for various marketplace-related inquiries and technical support.
Low impact
R13785FM: The Fiscal Intermediary Shared System (FISS) Submission of Copybook Files to the Provider Statistical & Reimbursement (PS&R) System
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes help desk contact details, hours of operation, and useful websites for Marketplace registration and training.
High impact
TMHP IAMOnline Activation Email Sent June 15, 2026
Texas Medicaid·Effective Jun 15, 2026
Texas Medicaid providers must activate their TMHP IAMOnline accounts by clicking the activation button in emails sent June 15, 2026. This is part of a new mandatory login process for all Texas Medicaid providers, and inactive accounts are automatically deactivated after 90 days.
Low impact
Registration is Open: 2026 Quality in Long-Term Care Conference
Texas Medicaid·Identified Jun 16, 2026
This policy announces registration for a 2026 Quality in Long-Term Care Conference scheduled for August 25-26, 2026 in Austin. This is an educational conference offering continuing education credits, not a billing or reimbursement policy change.
Medium impact
System Maintenance Outages Scheduled in July, August, and October of 2026
Texas Medicaid·Effective Jul 17, 2026
TMHP has scheduled system maintenance outages on three weekends in 2026 (July 17-19, August 28-30, and October 2-4) from Friday 7 PM to Sunday 11:59 PM Central time. During these outages, all web-based applications and functions will be unavailable, preventing online claim submissions and system access.
High impact
Alacura for Medical Transportation Management: Learn More
BCBS Texas·Effective Jan 1, 2025
Effective Jan 1, 2025, Blue Cross Blue Shield of Texas (BCBSTX) implemented Alacura Medical Transportation Management for prior authorization and review of air and ground medical transportation services. Ambulance providers must now contact Alacura at 866-671-4834 before all nonemergent, nonurgent transports for fully insured and retail PPO, POS, HMO members and ASO commercial members.
High impact
2026 Mental Health Codes and Maximum Adjusted Fee For Service (FFS) Rate by Date of Rate Change grid published
Minnesota Medicaid (MHCP)·Effective Feb 1, 2026
Minnesota Department of Human Services published updated Mental Health Codes and Maximum Adjusted Fee-for-Service (FFS) rates effective February 1, 2026. Billing teams must review the new rate grid and Page 1 guidance to understand when services qualify for adjusted reimbursement rates, as this supersedes previous mental health rate schedules.
Low impact
Public feedback needed about Early Intensive Developmental and Behavioral Intervention (EIDBI) licensing standards
Minnesota Medicaid (MHCP)·Identified Jun 16, 2026
The Minnesota Department of Human Services is seeking public feedback to develop comprehensive licensing standards for Early Intensive Developmental and Behavioral Intervention (EIDBI) services. This is a feedback collection period with no immediate billing or coverage changes; however, the resulting standards may impact EIDBI service delivery, billing codes, and provider requirements in Minnesota.
Medium impact
Minnesota WIC formula updates for health care providers
Minnesota Medicaid (MHCP)·Effective Jun 16, 2026
The Minnesota WIC (Women, Infants & Children) Program has updated its approved infant formula list for health care providers. Billing teams must consult the updated MDH WIC Formula Updates document (June 2026) and refer to the MDH WIC and Health Care Providers webpage to ensure accurate billing and documentation for WIC-covered formula products.
Medium impact
Reprocessing of incorrectly denied transportation claims
Minnesota Medicaid (MHCP)·Effective Jun 16, 2026
Minnesota Department of Human Services has resolved a system error that was incorrectly denying transportation claims for codes A0170, A0180, and A0190 with dates of service from October 1, 2025 through June 1, 2026. No action is required from providers; the state automatically reprocessed all impacted claims, which will appear on warrants starting June 16, 2026 and be fully completed by June 30, 2026.
Medium impact
Medical and Clinical Policy Updates - Effective September 1, 2026
Sentara Health Plans·Effective Sep 1, 2026
Sentara Health Plans has updated 24 medical policies effective September 1, 2026, including reviews, revisions, and archival of existing policies across surgical, behavioral health, medical, and DME categories. Key changes include revised policies for wound treatment supplies, hearing aids/implants, sleep apnea surgery, and diabetes management, plus archival of policies for fetal cardiac imaging, continuous glucose monitoring, insulin pumps, and scalp cooling. Billing teams must identify which policies apply to their patient population and update authorization and coverage rules accordingly.
Low impact
2026 CDPHP Workforce Team Challenge Raises a Record $50,000 for Local Not-for-Profits
CDPHP·Identified Jun 15, 2026
This is a press release announcing CDPHP's 2026 Workforce Team Challenge fundraising event that raised $50,000 for local nonprofits. This is NOT a policy change affecting billing, coverage, prior authorization, coding, or reimbursement. No operational changes are required for the medical billing team.
Medium impact
Justice-Involved (JI) Reentry Initiative: Telecommunications Modifier GQ is Reimbursable
Medi-Cal·Effective Oct 1, 2024
Medi-Cal now reimburses modifier GQ (asynchronous telecommunications/store-and-forward) for Justice-Involved (JI) reentry services provided by embedded and in-reach providers, including FQHCs and RHCs. This applies retroactively to October 1, 2024, and includes automatic reprocessing of previously denied claims.
Medium impact
Justice-Involved (JI) Reentry Initiative: Provider Types Updated for General and Care Management Services
Medi-Cal·Effective Oct 1, 2024
The Justice-Involved Reentry Initiative has updated which provider types can deliver general and care management services to justice-involved individuals in Medi-Cal. Several provider types including community clinics, optometrists, and pharmacists have been added, while others like physical therapists, occupational therapists, and speech therapists have been removed from eligibility.
Low impact
August 2026 Medi-Cal In-Person Training Event
Medi-Cal·Effective Aug 11, 2026
Medi-Cal is hosting a free in-person training event on August 11, 2026, in Santa Barbara offering billing courses and individual claims assistance. Registration is required by August 10, 2026, through the Medi-Cal Learning Portal.
Medium impact
New Requirement for Provider Verification in Telephone Service Center
Medi-Cal·Effective Aug 1, 2026
Starting August 1, 2026, providers calling the Telephone Service Center will need to verify their identity using their most recent checkwrite amount instead of previous verification methods. This permanent security enhancement affects all provider interactions requiring verification when contacting support.
Medium impact
[Georgia] Policy Updates January 2025
CareSource·Effective Mar 1, 2025
CareSource Georgia Medicaid has updated three policies effective March 1, 2025: Claims Editing and Review, Coordination of Benefits, and Cerumen Removal procedures. The Coordination of Benefits policy revision may impact prior authorization requirements.

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Archive by year

2023 2024 2025 2026

R242SOMA: Revisions to the State Operations Manual (SOM) Chapter 9 Exhibits.

R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197

R13816OTN: Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange(EDI) Front End Updates for October 2026

R13818OTN: Implementation of Editing for Programs of All-Inclusive Care for the Elderly (PACE) Inpatient Claims Submitted for Indirect Medical Education (IME) Payment

R13821PI: Updates of Chapters 3, 4, and Exhibits in Publication (Pub.) 100-08, Including Updates to the Provider Notification Process and Vetting with the CMS Process

R13822CP: Quarterly Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)

R13825FM: Updates to the Internet Only Manual, Publication 100-06, Chapter 3, Overpayments, Section 140-140.8.4 - Bankruptcy

R13826CP: Medicare Beneficiary Date of Death - Manual Update

R243SOMA: Revisions to State Operations Manual (SOM), Chapter 5

R13785FM: The Fiscal Intermediary Shared System (FISS) Submission of Copybook Files to the Provider Statistical &amp; Reimbursement (PS&amp;R) System

TMHP IAMOnline Activation Email Sent June 15, 2026

Registration is Open: 2026 Quality in Long-Term Care Conference

System Maintenance Outages Scheduled in July, August, and October of 2026

Alacura for Medical Transportation Management: Learn More

2026 Mental Health Codes and Maximum Adjusted Fee For Service (FFS) Rate by Date of Rate Change grid published

Public feedback needed about Early Intensive Developmental and Behavioral Intervention (EIDBI) licensing standards

Minnesota WIC formula updates for health care providers

Reprocessing of incorrectly denied transportation claims

Medical and Clinical Policy Updates - Effective September 1, 2026

2026 CDPHP Workforce Team Challenge Raises a Record $50,000 for Local Not-for-Profits

Justice-Involved (JI) Reentry Initiative: Telecommunications Modifier GQ is Reimbursable

Justice-Involved (JI) Reentry Initiative: Provider Types Updated for General and Care Management Services

August 2026 Medi-Cal In-Person Training Event

New Requirement for Provider Verification in Telephone Service Center

[Georgia] Policy Updates January 2025

R13785FM: The Fiscal Intermediary Shared System (FISS) Submission of Copybook Files to the Provider Statistical & Reimbursement (PS&R) System