All Insurance Policy Changes (Page 130)

Continuing from page 129. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
Tips and documentation standards for interactive complexity and psychotherapy with E/M services
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
This policy clarifies correct documentation and billing standards for interactive complexity add-on code +90785 and psychotherapy codes when billed with E/M services. Key changes emphasize that +90785 applies only to documented interactional barriers requiring active management (not emotional difficulty), psychotherapy requires minimum 16 minutes of face-to-face therapeutic work with specific clinical documentation, and E/M and psychotherapy time must be separately tracked and documented to avoid compliance violations.
Low impact
July is Minority Mental Health Awareness Month
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
This is an informational policy from BCBS Rhode Island recognizing July as Minority Mental Health Awareness Month. It provides guidance to clinicians on developing cultural competence in behavioral health care, including self-examination of biases, cultural knowledge-seeking, patient dialogue, and culturally appropriate screening. This is awareness and educational content, not a billing or coverage policy change.
Low impact
Best practices for HEDIS measures related to mental health
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
This is an informational policy update from Blue Cross Blue Shield Rhode Island regarding best practices for HEDIS (Healthcare Effectiveness Data and Information Set) measures related to mental health. The policy explains HEDIS as a performance improvement tool used to assess quality of care and identify improvement areas, but does not specify new billing requirements, code changes, or coverage modifications affecting current billing workflows.
Medium impact
Charlie Health Virtual IOP
Blue Cross Blue Shield of Rhode Island·Effective May 1, 2026
BCBS Rhode Island has contracted with InStride Health, a virtual behavioral health provider specializing in anxiety and OCD treatment for ages 7-22. InStride is now a nationally contracted provider within the BCBSRI network, allowing services to expand beyond Rhode Island to members in other states. This is a new in-network provider addition for commercial members effective May 1, 2026.
Low impact
Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey 101
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
This is an informational policy explaining the CAHPS survey methodology and its role in evaluating provider and health plan performance. The survey measures patient experience across access, communication, coordination, and customer service, with results influencing Star Ratings effective July 1, 2026. While not a billing code or coverage change, the practice should ensure clinical and administrative workflows support positive patient experiences across all touchpoints to optimize CAHPS results.
Medium impact
Reminder: Verify your practice information!
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBSRI requires practices to verify and maintain accurate demographic information in their Find a Doctor directory within 60 days of any changes. This is a CMS requirement and contractual obligation. Practices must ensure two key data points are current: whether the location is where patients can schedule appointments and whether the provider is accepting new patients.
High impact
Reminder: Pharmacy post-claim review medications effective May 1, 2026
Blue Cross Blue Shield of Rhode Island·Effective May 1, 2026
BCBS Rhode Island is implementing a new pharmacy post-claim review process for in-scope medications effective May 1, 2026. Providers must now obtain prior authorizations through a new platform (GatewayPA.com) or by phone (1-833-895-8282) for medical benefit drugs with dates of service on or after May 1, 2026, while self-administered drugs continue through CoverMyMeds and fax.
High impact
Prepayment change reminder
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2024
BCBSRI has implemented enhanced prepayment claim reviews using Optum's Comprehensive Payment Integrity (CPI) tool effective July 1, 2024. Providers may now be requested to submit medical records and billing documentation before claims are paid to verify accurate coding, appropriate utilization, and medical necessity. Claims will only be processed for payment if documentation supports the charges as billed.
Medium impact
Astrana Health Utilization Management System Transition
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
Astrana Health is transitioning to a new Utilization Management system effective July 1, 2026. During this transition, providers may continue submitting authorization requests via fax or telephone with no anticipated interruption to UM review operations. Training for the new provider portal will be shared separately.
High impact
Requirement to refer members to in-network providers
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBSRI now requires all contracted providers to refer members exclusively to in-network providers for all services including durable medical equipment, radiology, behavioral health, and laboratory/pathology services. The policy specifically identifies four laboratories (Accu Reference Lab, Quest Diagnostics, Total Toxicology, U.S. Lab and Radiology, Inc.) that are NOT in the BCBSRI network and must be avoided. Providers must verify in-network status using the BCBSRI Find a Doctor tool before establishing referral relationships.
Medium impact
National Plan and Provider Enumeration System Reminder
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
CMS is reminding Medicare Advantage Organizations to work with contracted providers to review, update, and certify provider information in the National Plan and Provider Enumeration System (NPPES). Providers must ensure all active practice locations are listed with current contact information, remove inactive locations, and formally certify the accuracy of their data in NPPES. Note: NPPES updates do not affect Medicare Fee-For-Service billing.
High impact
Medicaid coverage of Medicare cost sharing
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBS Rhode Island clarifies that Medicaid must cover Medicare cost sharing (copays and coinsurance) for DSNP members on specific services including PCP visits (excluding annual physicals), X-ray-related medical services, specialist visits, and Part B DME supplies. Providers who are not approved Medicaid providers cannot bill members for these cost-sharing amounts and must submit claims to Medicaid instead.
High impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBSRI clarifies that Medicare Advantage out-of-network providers must be paid at FFS Medicare rates and must accept this payment in full without balance billing members. Providers are required to bill BCBSRI for Medicare members and cannot use their participating provider contracts to negotiate higher rates for MA out-of-area claims.
Low impact
Provider race and ethnicity
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBS Rhode Island will begin publishing provider race and ethnicity information in their Find a Doctor directory, obtained from voluntary CAQH database disclosures. This is an informational policy supporting NCQA Health Equity Accreditation and does not affect billing, coding, or claims processing.
Medium impact
Access to care standards for all providers
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBS Rhode Island has updated its Access to Care Standards effective July 1, 2026, establishing new access and monitoring standards for members' access to PCPs, behavioral health providers, and specialists. The policy clarifies PCP definitions to include board-certified physicians in internal medicine, pediatrics, or family medicine, as well as nurse practitioners, physician assistants, and some Ob/Gyns meeting state licensing and certification requirements. Billing teams must ensure provider credentialing and referral workflows align with these updated PCP qualification standards.
Low impact
Provider utilization management satisfaction survey
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
BCBS Rhode Island has added a provider satisfaction survey to its Prior Authorization page on BCBSRI.com, effective July 1, 2026. The survey is now accessible year-round to collect continuous feedback on utilization management services. This is an informational enhancement with no changes to billing processes, prior authorization requirements, or claims handling.
Low impact
[Indiana] Save the Date: July 2026 Behavioral Health Live Orientation
CareSource·Identified Jul 1, 2026
CareSource Indiana is hosting a live provider orientation for behavioral health on July 16, 2026. This is an informational event tailored for newly contracted behavioral health providers and care facilities to discuss operational topics and answer questions.
High impact
[Indiana] July 2026 Policy Updates
CareSource·Effective Sep 1, 2026
CareSource Indiana Medicaid released four policy updates effective September 1, 2026, including revisions to modifier usage (Modifier 25 and modifiers 59/XE/XP/XS/XU), dental services billing in facility settings, and infant formula coverage. The billing team must review each policy detail on CareSource.com to understand specific reimbursement rule changes before the effective date.
High impact
[Ohio] July 2026 Policy Updates
CareSource·Effective Sep 1, 2026
CareSource Ohio Medicaid released 12 policy updates effective September 1, 2026 and October 1, 2026, including new reimbursement policies for Applied Behavior Analysis, EKG Interpretations, E/M and Psychotherapy, and dental anesthesia services, plus revisions to existing medical and administrative policies. Billing teams must review each policy individually on the CareSource website to identify specific code changes, documentation requirements, and billing rule updates before the effective dates.
High impact
[Ohio] OAC 5160-13-08, Add-On Payment for Nursing Facility-Based Hemodialysis Furnished by a Dialysis Center
CareSource·Effective Jul 1, 2026
Ohio Medicaid (ODM) has implemented a new add-on payment of $110 per treatment for nursing facility-based hemodialysis services furnished by dialysis centers, effective July 1, 2026. Billing teams must use the designated HD revenue center code with an ODM-specified modifier to claim this add-on payment, which is available only during SFY 2027, for dialysis centers already providing these services, and until the $2.1M budget cap is reached.
High impact
Dental Rate Increase Retro Effective 9/1/2025
Arkansas Medicaid·Effective Sep 1, 2025
Arkansas has implemented a dental rate increase effective retroactively to September 1, 2025. This policy affects dental procedure codes and requires billing teams to update reimbursement rates in their systems to reflect the new fee schedule posted on June 30, 2026.
Medium impact
R530PR1: Section 2231, Regional Medicare Swing-Bed-Rates, updates Table 38 to correct the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2027.  These rates should be used to carve out swing-bed costs
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
R26P240i: This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by clarifying and revising the existing instructions and by revising existing edits. Effective dates vary.
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
R13829CP: Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 32.3, Effective October 1, 2026
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change
Medium impact
R13831CP: October 2026 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
Medicare/CMS - Transmittals·Identified Jul 1, 2026
Failed to analyze policy change

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Archive by year

2023 2024 2025 2026

Tips and documentation standards for interactive complexity and psychotherapy with E/M services

July is Minority Mental Health Awareness Month

Best practices for HEDIS measures related to mental health

Charlie Health Virtual IOP

Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey 101

Reminder: Verify your practice information!

Reminder: Pharmacy post-claim review medications effective May 1, 2026

Prepayment change reminder

Astrana Health Utilization Management System Transition

Requirement to refer members to in-network providers

National Plan and Provider Enumeration System Reminder

Medicaid coverage of Medicare cost sharing

Medicare Advantage claims for out-of-network payments

Provider race and ethnicity

Access to care standards for all providers

Provider utilization management satisfaction survey

[Indiana] Save the Date: July 2026 Behavioral Health Live Orientation

[Indiana] July 2026 Policy Updates

[Ohio] July 2026 Policy Updates

[Ohio] OAC 5160-13-08, Add-On Payment for Nursing Facility-Based Hemodialysis Furnished by a Dialysis Center

Dental Rate Increase Retro Effective 9/1/2025

R530PR1: Section 2231, Regional Medicare Swing-Bed-Rates, updates Table 38 to correct the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2027. &nbsp;These rates should be used to carve out swing-bed costs

R26P240i: This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by clarifying and revising the existing instructions and by revising existing edits. Effective dates vary.

R13829CP: Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 32.3, Effective October 1, 2026

R13831CP: October 2026 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

R530PR1: Section 2231, Regional Medicare Swing-Bed-Rates, updates Table 38 to correct the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2027. These rates should be used to carve out swing-bed costs