All Insurance Policy Changes (Page 1304)

Continuing from page 1303. 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
November 19, 2025 Will AI rules leave small hospitals behind? Policymakers can design regulations that protect patients and work for …
Kaiser Permanente·Identified Jun 6, 2026
This appears to be a news article or feature story about AI regulations and their potential impact on small hospitals, rather than a specific insurance policy change. The content provided shows metadata tags and URL information but no actual policy details or billing/coverage changes.
Low impact
December 9, 2025 Buprenorphine saves lives. Why can’t more patients get it? Policy changes are crucial for better opioid addiction treatment.
Kaiser Permanente·Identified Jun 6, 2026
This appears to be a news article about buprenorphine access for opioid addiction treatment rather than a specific insurance policy change. The content provided shows HTML metadata and article tags but does not contain actionable billing policy changes or requirements.
Low impact
New IAMOnline User Guide Now Available
Texas Medicaid·Identified Jun 6, 2026
Texas Medicaid & Healthcare Partnership (TMHP) has released a new user guide for accessing their applications through IAMOnline. The guide is available on TMHP's Learning Management System and covers implementation details, application access procedures, and account security management.
Medium impact
Telecommunications and Teledentistry Services to Be Updated in CSHCN Services Program Provider Manual
Texas Medicaid·Effective Aug 14, 2026
Effective August 14, 2026, Texas Medicaid will update documentation requirements for telemedicine, teledentistry, and telehealth services in the CSHCN Services Program. Providers must comply with Texas Occupational Code requirements, document informed consent, and follow specific record retention requirements for data collection and sharing.
Low impact
HHSC Publishes Provider Letter 2026-08, Retired Program Provider Letters
Texas Medicaid·Identified Jun 6, 2026
HHSC has published Provider Letter 2026-08 announcing that certain provider letters have been retired and are no longer available on the HHSC website. Providers must destroy any saved copies of the retired provider letters and should not rely on the information contained in them.
High impact
[Ohio] Updating guidance for prior authorization documentation
Anthem BCBS·Effective May 1, 2026
Ohio Medicaid/MyCare Ohio updated prior authorization documentation requirements effective May 1, 2026 for acute rehabilitation, nursing facility, DME, home health, and private duty nursing services. Billing teams must now ensure specific documentation (preadmission screenings, PASRR forms, certificates of medical necessity, face-to-face encounters, and care provider orders) accompany all PA requests to avoid processing delays or claim denials.
High impact
[Ohio] ODM clarifies Third-Party Liability (TPL) and Coordination of benefits (COB)
Anthem BCBS·Effective Jun 4, 2026
Ohio Medicaid (ODM) has clarified strict Third-Party Liability (TPL) and Coordination of Benefits (COB) requirements, mandating that providers must make documented reasonable efforts to obtain payment from all liable third-party payers before billing Anthem. Providers must meet specific conditions (claim denial, multiple submission attempts, prior service verification, or documentation of no coverage) to satisfy TPL requirements. Failure to comply may result in claim denials or recoupments.
Medium impact
Reimbursement Rate Updates for HCPCS Drug Procedure Code J7601 Effective January 1, 2025
Texas Medicaid·Effective Jan 1, 2025
Texas Medicaid (TMHP) is implementing reimbursement rate changes for HCPCS drug procedure code J7601 effective January 1, 2025. TMHP will automatically identify and reprocess affected claims, with adjustments appearing in future Remittance and Status Reports.
Medium impact
2026-06-04 - Federal Rule Takes Aim at Health Care Bureaucracy, Reducing Dispute Fees & Boosting Transparency
Medicare/CMS·Effective Jul 1, 2026
CMS finalized major reforms to the No Surprises Act's Federal Independent Dispute Resolution process to make out-of-network payment disputes more efficient and reduce administrative costs. Additionally, Medicare GLP-1 Bridge educational materials were released for the July 1, 2026 program start, and several other updates affecting various specialties.
Medium impact
Coverage Added for J0174 and J0175
Arkansas Medicaid·Effective Jun 5, 2026
Arkansas has added coverage for HCPCS codes J0174 and J0175 (pharmacy procedure codes). The billing team must verify these codes are now covered and billable for Arkansas Medicaid claims effective immediately.
Low impact
Waiver and AC Resources and MN–ITS Training certificates for June session sent
Minnesota Medicaid (MHCP)·Effective Jun 5, 2026
The Minnesota Department of Human Services has distributed certificates of completion to providers who attended the June 2-3, 2026 Waiver and Alternative Care (AC) Resources and MN–ITS Training sessions. Certificates were sent to providers' MN–ITS mailboxes under their registered National Provider Identifier (NPI) and should be accessible by end of business June 5, 2026 in the 'Miscellaneous Received' PRVLTR folder.
Medium impact
[Virginia] Notice of upcoming professional provider amendment
Anthem BCBS·Effective Oct 1, 2026
Anthem Blue Cross Blue Shield (Virginia) will send a professional provider contract amendment effective October 1, 2026. Providers must access the amendment details through Anthem's Provider Online Reporting application on Availity Essentials to review updated fee schedules and contract terms. This is an administrative notification requiring organizations to register tax IDs and configure portal access before the effective date.
Low impact
Acceptable Plans of Correction for HCS and TxHmL Providers In-Person Training
Texas Medicaid·Effective Jun 9, 2026
Texas Medicaid Health Partnership (TMHP) is offering mandatory training for HCS and TxHmL providers on writing acceptable Plans of Correction and the Informal Dispute Resolution process. The training is scheduled for June 9, 2026, in Tyler, Texas, and providers must register and attend to receive a certificate of attendance.
Low impact
Helping patients get started with behavioral health support
Cigna·Effective Jun 3, 2026
Cigna Healthcare has published new guidance for providers on helping patients access behavioral health resources including EAPs, covered therapy services, and digital mental health tools. This is informational guidance rather than a policy change affecting billing procedures.
High impact
Spring 2026 Medical and Clinical Policy Updates
Sentara Health Plans·Effective May 1, 2026
Sentara Health Plans has completed a comprehensive Spring 2026 medical and clinical policy review across January, February, and March 2026. This newsletter announces 73 policy changes affecting medical, surgical, DME, imaging, obstetric, and behavioral health services with multiple effective dates (May 1, June 1, and July 1, 2026). Most policies were either archived (no longer covered), reviewed (coverage confirmed with potential updates), or revised (coverage modified). Billing teams must identify which specific policies affect their practice's services and update systems accordingly before the staggered effective dates.
Medium impact
Updates to Skin Substitute Procedures
Arkansas Medicaid·Identified Jun 4, 2026
Failed to analyze policy change
Low impact
Black History Month: Treat chronic kidney disease
UnitedHealthcare·Identified Jun 3, 2026
UnitedHealthcare has published educational content highlighting chronic kidney disease (CKD) disparities in Black communities during Black History Month. This is informational content providing educational resources and continuing education opportunities for providers, not a policy change affecting billing or coverage.
Low impact
Women’s Health Month: Not all heart attacks look the same
UnitedHealthcare·Identified Jun 3, 2026
This is an educational article about recognizing atypical heart attack symptoms in women, not a policy change. UnitedHealthcare published this as part of Women's Health Month to help providers understand that women often present with subtle symptoms like back, neck, jaw, or abdominal pain rather than classic chest pain.
Medium impact
Complete required special needs plan training by Dec. 31
UnitedHealthcare·Effective Dec 31, 2026
UnitedHealthcare requires all network providers who see Special Needs Plan (SNP) members to complete mandatory Model of Care (MOC) training by December 31, 2026. This is a CMS requirement for initial and annual training that takes about 10 minutes to complete online.
Low impact
Onboard Pro now offers bulk single and multistate credentialing
UnitedHealthcare·Effective Mar 1, 2026
UnitedHealthcare launched Onboard Pro bulk credentialing enhancements that allow organizations to submit up to 50 providers at once and credential up to 10 states per bulk submission. This new feature is available through the UnitedHealthcare Provider Portal to simplify and accelerate provider onboarding.
Medium impact
UnitedHealthcare Choice Plus is in network for the New York City Employees PPO Plan
UnitedHealthcare·Effective Jan 1, 2026
UnitedHealthcare Choice Plus is now in-network for the New York City Employees PPO Plan, providing coverage for NYC employees and retirees throughout the U.S. (except 13 downstate NY counties). Billing teams must use the NYCE PPO provider portal exclusively for all transactions and use specific EDI payer IDs for claims submission.
Medium impact
Medicaid: New cervical cancer screening guidelines
UnitedHealthcare·Effective Feb 5, 2026
New Medicaid cervical cancer screening guidelines now allow patient-collected hrHPV testing for women aged 30-65 and establish hrHPV testing every 5 years as the preferred method over cytology alone. These changes align with HEDIS technical specifications and allow self-collected samples to count toward quality reporting.
Medium impact
BAI codes identify real-time transactions for select commercial claim payments
UnitedHealthcare·Effective Mar 1, 2026
Starting early March 2026, UnitedHealthcare will implement real-time electronic funds transfers (EFTs) for eligible commercial claim payments, identified by new BAI codes 158, 159, 399, and 459 on bank remittance reports. This change eliminates the standard 3-5 day payment timeline for immediate fund release but requires providers to be enrolled in ACH payments with banks that support real-time processing.
High impact
Medicare: New prior authorization process for certain oncology procedures
UnitedHealthcare·Effective Jun 1, 2026
Effective June 1, 2026, UnitedHealthcare will require prior authorization for outpatient chemotherapy services using the Optum Cancer Guidance Program for members under the UnitedHealthcare Nursing Home Plan and UnitedHealthcare Care Advantage Plan. Any existing regimen approvals granted before this date will need to be resubmitted through the new CGP process.
Medium impact
Medicare Advantage referrals: No immediate claim denials
UnitedHealthcare·Effective Jan 1, 2026
UnitedHealthcare is extending the grace period for Medicare Advantage HMO referral requirements, continuing to defer claim denials for missing referrals beyond the original April 30, 2026 end date. PCPs must still submit referrals for specialty services starting January 1, 2026, but claims won't be denied during this extended grace period.

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November 19, 2025 Will AI rules leave small hospitals behind? Policymakers can design regulations that protect patients and work for …

December 9, 2025 Buprenorphine saves lives. Why can’t more patients get it? Policy changes are crucial for better opioid addiction treatment.

New IAMOnline User Guide Now Available

Telecommunications and Teledentistry Services to Be Updated in CSHCN Services Program Provider Manual

HHSC Publishes Provider Letter 2026-08, Retired Program Provider Letters

[Ohio] Updating guidance for prior authorization documentation

[Ohio] ODM clarifies Third-Party Liability (TPL) and Coordination of benefits (COB)

Reimbursement Rate Updates for HCPCS Drug Procedure Code J7601 Effective January 1, 2025

2026-06-04 - Federal Rule Takes Aim at Health Care Bureaucracy, Reducing Dispute Fees & Boosting Transparency

Coverage Added for J0174 and J0175

Waiver and AC Resources and MN–ITS Training certificates for June session sent

[Virginia] Notice of upcoming professional provider amendment

Acceptable Plans of Correction for HCS and TxHmL Providers In-Person Training

Helping patients get started with behavioral health support

Spring 2026 Medical and Clinical Policy Updates

Updates to Skin Substitute Procedures

Black History Month: Treat chronic kidney disease

Women’s Health Month: Not all heart attacks look the same

Complete required special needs plan training by Dec. 31

Onboard Pro now offers bulk single and multistate credentialing

UnitedHealthcare Choice Plus is in network for the New York City Employees PPO Plan

Medicaid: New cervical cancer screening guidelines

BAI codes identify real-time transactions for select commercial claim payments

Medicare: New prior authorization process for certain oncology procedures

Medicare Advantage referrals: No immediate claim denials