All Insurance Policy Changes (Page 1297)

Continuing from page 1296. 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
[Georgia] Precertification/prior authorization requirement changes
Anthem BCBS·Effective Sep 1, 2026
Anthem Blue Cross and Blue Shield of Georgia is adding prior authorization requirements for 26 specific medical codes effective September 1, 2026, for Medicare Advantage members only. These codes span multiple specialties including gastroenterology, oncology, neurostimulation procedures, and various surgical interventions.
Medium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Oct 1, 2026
Starting October 1, 2026, two genetic testing codes (0628U for kidney disease and 0630U for breast cancer) will require prior authorization through Carelon Medical Benefits Management for Georgia Medicare Advantage plans. Providers must obtain authorization before performing these tests to avoid claim denials.
High impact
[Georgia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines for radiology, vascular imaging, and cardiology services effective September 19, 2026. Changes include expanded allowances for certain imaging procedures, modified prior authorization requirements, and updated surveillance intervals for various conditions.
High impact
[Virginia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective September 19, 2026, affecting imaging (radiology, vascular, cardiac), cardiology procedures, and cardiac devices. Changes include expanded indications for advanced imaging (CT, CTA, MRA, PET), modified pre/post-operative imaging requirements, alignment with updated professional society guidelines, and clarified criteria for percutaneous coronary intervention and implantable cardiac devices. Billing teams must review affected departments' protocols and ensure prior authorization requests align with new clinical criteria.
High impact
[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management has updated clinical appropriateness guidelines effective September 19, 2026, with expansions and modifications across radiology, cardiology, and vascular imaging. Key changes include expanded CT indications for brain perfusion, new vascular imaging criteria (particularly for CTA/MRA), relaxed requirements for some orthopedic imaging (meniscal tears, TFCC instability), modified cardiac device criteria (expanded wearable cardioverter defibrillators and dual-chamber leadless pacemakers), and removal of certain PCI criteria based on recent clinical evidence. Billing teams must review updated approval criteria for imaging and cardiac procedures to ensure proper prior authorization and claims submission.
High impact
[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective September 19, 2026, across radiology, cardiology, and vascular imaging. Changes include expanded indications for brain CT perfusion, modified requirements for extremity and spine imaging, new vascular imaging criteria, and updated cardiac device placement guidelines. Prior authorization requirements and frequency limitations have been modified to align with current professional society guidelines.
High impact
[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective September 19, 2026, affecting imaging authorization criteria across radiology, vascular, and cardiology specialties. Changes include expanded indications for advanced imaging (CT, CTA, MRI, PET), removed indications for certain procedures (e.g., advanced vascular imaging for syncope), modified pre- and post-operative imaging requirements, and updated cardiac device implantation criteria. Billing teams must review prior authorization rules and update system protocols to reflect new/removed indications and modified frequency limitations.
High impact
[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective September 19, 2026, affecting radiology, vascular imaging, and cardiology procedures. Key changes include expanded indications for brain CT perfusion, modified vascular imaging requirements (duplex ultrasound now required before CTA/MRA for stroke/TIA symptoms >30 days), new cardiac MRI criteria, removal of non-culprit PCI after STEMI, expanded wearable cardioverter defibrillator criteria, and new dual-chamber leadless pacemaker approvals. Billing teams must update prior authorization workflows and clinical review criteria to align with these evidence-based guideline updates.
High impact
[California] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·Effective Sep 19, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective September 19, 2026, with expanded indications for imaging (CT, CTA, MRA, ultrasound, PET/CT), modified cardiac intervention criteria, and refined surveillance intervals across radiology, vascular, and cardiology specialties. These changes align with recent professional society guidelines and affect authorization requirements for multiple imaging modalities and cardiac procedures.
High impact
New Login Process for All Texas Medicaid Providers Through TMHP IAMOnline and Provider MFA Registration for Transition Release 3
Texas Medicaid·Effective Aug 3, 2026
Texas Medicaid providers must transition to a new TMHP IAMOnline login system with multi-factor authentication by August 3, 2026. Providers need to activate their accounts within 7 days of receiving activation emails (June 8 or June 15) to access Custom Reports, Medicaid Client Portal, Document Uploads, Provider Message Dashboard, and My Account applications.
Low impact
PEMS and PA on the Portal Training Materials Now Include TMHP IAMOnline Details for Transition Release 1 Effective June 12, 2026
Texas Medicaid·Effective Jun 12, 2026
TMHP has updated training materials for the Provider Enrollment and Management System (PEMS) and Prior Authorization Portal to include new TMHP IAMOnline login steps. Updated training materials are now available on the Learning Management System (LMS) and require users to create new accounts for access.
Low impact
Updated TMHP My Account User Guide Now Available
Texas Medicaid·Identified Jun 13, 2026
TMHP has released an updated My Account User Guide available on their Learning Management System and Account Management web page. The guide helps providers create and manage TMHP user accounts linked to NPI or API identifiers, and learn about enrolling in Texas Medicaid and non-Medicaid programs.
Medium impact
Review of Inpatient Claims for Spell-of-Illness Limitation
Texas Medicaid·Identified Jun 13, 2026
Texas Medicaid is conducting a utilization review of inpatient claims from May 23, 2024, through April 21, 2026, to identify claims paid outside the 30-day spell-of-illness limitation. Excess payments may be recouped through deductions from future payments, which will appear on Remittance and Status (R&S) Reports.
Medium impact
Adult Vaccines Added to the Medicaid Formulary on June 1, 2026
Texas Medicaid·Effective Jun 1, 2026
Effective June 1, 2026, Texas Medicaid now covers all recommended adult vaccines (ages 19+) as pharmacy benefits, allowing reimbursement for both vaccine ingredients and administration costs. Pharmacies must have a Collaborative Practice Agreement or patient-specific prescription to administer vaccines under this benefit.
Medium impact
EFT Payments Delayed Due to Juneteenth Bank Holiday
Texas Medicaid·Effective Jun 19, 2026
Electronic funds transfer (EFT) payments will be delayed by one business day due to the Juneteenth bank holiday on Friday, June 19, 2026. Providers expecting EFT payments should anticipate receiving funds on Monday, June 22, 2026, instead of the usual Friday deposit.
Low impact
Updated LTC R&S Reports Videos Now Available
Texas Medicaid·Identified Jun 13, 2026
TMHP has updated training videos for Long-term Care Remittance and Status (R&S) Reports and changed column headers in TexMedConnect to improve clarity and alignment with Texas Comptroller data. The column headers for warrant information have been simplified and standardized across the Financial Summary, Pending Claims, and Non-Pending Claims pages.
Low impact
New Intake Line for Community Care Services
Texas Medicaid·Identified Jun 13, 2026
Texas Health and Human Services Commission created a new statewide phone line (888-241-1570) for community care services intake, which directs callers to local offices based on ZIP code. This affects referrals and coordination for various community-based services including adult foster care, personal attendant services, and home delivered meals.
Low impact
Register for Long-Term Care Webinar on June 17
Texas Medicaid·Effective Jun 17, 2026
TMHP is offering a free educational webinar on antibiotic stewardship in long-term care facilities, scheduled for June 17 from 12-1 PM Central. This is an informational announcement about continuing education opportunities for nursing staff and administrators, not a policy change affecting billing practices.
Medium impact
Texas Medicaid & Healthcare Partnership IAMOnline Activation Email Sent on June 8, 2026
Texas Medicaid·Effective Jun 8, 2026
Texas Medicaid providers received IAMOnline activation emails on June 8, 2026 and must follow the instructions to activate their accounts. TMHP user accounts are automatically deactivated after 90 days of inactivity.
Low impact
HHSC Published Guidance for Informal Dispute Resolution Process Long-term Care Regulation Provider Letter
Texas Medicaid·Identified Jun 13, 2026
HHSC has published revised guidance for the Informal Dispute Resolution (IDR) process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers. The process now uses Michigan Peer Review Organization as the independent third-party for IDR reviews instead of the previous system.
Medium impact
Holidays Impacting LTC FFS Claim Processing/Payment Timeline
Texas Medicaid·Identified Jun 13, 2026
TMHP has published a list of bank holidays that impact Long-Term Care Fee-for-Service claim processing and payment timelines. Bank holidays are non-business days and do not count toward processing timelines, so providers need to account for these when calculating expected payment dates.
Low impact
Summary of Provider Newsroom U.S. commercial medical articles
Cigna·Identified Jun 13, 2026
This is a monthly summary document listing all Provider Newsroom articles published in May 2026, covering topics like mental health resources, depression screening, prostate cancer education, post-payment reviews, and system updates. No specific policy changes or billing requirements are introduced in this summary.
Low impact
Summary of Provider Newsroom behavioral health articles
Cigna·Identified Jun 13, 2026
This is an informational summary of Cigna's May 2026 behavioral health articles covering topics like LAI antipsychotic administration, men's mental health, SUD treatment engagement, and access to care results. No billing or policy changes are introduced.
Medium impact
Avoid the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
BCBS Texas·Effective Jan 14, 2026
Blue Cross Blue Shield of Texas issued guidance discouraging the inappropriate use of antipsychotic medications for anxiety disorders, as most antipsychotics are not FDA-approved for conditions like panic disorder and generalized anxiety disorder. The policy emphasizes evidence-based treatment guidelines and includes quality measures for metabolic monitoring when antipsychotics are prescribed.
Low impact
Look for Your Medicare Advantage Access and Availability Survey
BCBS Texas·Effective Feb 15, 2026
Blue Cross Blue Shield of Texas will conduct a biannual Medicare Advantage provider survey in mid-February 2026 to assess appointment wait times and network accessibility compliance with CMS requirements. Selected providers will receive a brief 3-question email survey about wait times for emergency, primary care, and behavioral health services.

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Archive by year

2023 2024 2025 2026

[Georgia] Precertification/prior authorization requirement changes

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Virginia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[California] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

New Login Process for All Texas Medicaid Providers Through TMHP IAMOnline and Provider MFA Registration for Transition Release 3

PEMS and PA on the Portal Training Materials Now Include TMHP IAMOnline Details for Transition Release 1 Effective June 12, 2026

Updated TMHP My Account User Guide Now Available

Review of Inpatient Claims for Spell-of-Illness Limitation

Adult Vaccines Added to the Medicaid Formulary on June 1, 2026

EFT Payments Delayed Due to Juneteenth Bank Holiday

Updated LTC R&S Reports Videos Now Available

New Intake Line for Community Care Services

Register for Long-Term Care Webinar on June 17

Texas Medicaid & Healthcare Partnership IAMOnline Activation Email Sent on June 8, 2026

HHSC Published Guidance for Informal Dispute Resolution Process Long-term Care Regulation Provider Letter

Holidays Impacting LTC FFS Claim Processing/Payment Timeline

Summary of Provider Newsroom U.S. commercial medical articles

Summary of Provider Newsroom behavioral health articles

Avoid the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders

Look for Your Medicare Advantage Access and Availability Survey