All Insurance Policy Changes (Page 1308)

Continuing from page 1307. 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
New Jersey Medicaid: Discover new program for serious illness care
UnitedHealthcare·Effective Apr 1, 2026
UnitedHealthcare Community Plan of New Jersey launched a new Community-Based Palliative Care (CBPC) program for New Jersey FamilyCare (Medicaid) members effective April 1, 2026. Healthcare professionals can perform assessments using new HCPCS codes, but must enroll in the CBPC network to bill the PMPM bundle service to avoid claim denials.
Medium impact
Massachusetts Medicaid: Reporting requirements for SREs and PPCs
UnitedHealthcare·Identified Jun 2, 2026
Massachusetts Medicaid has updated reporting requirements for Serious Reportable Events (SREs) and Potentially Preventable Complications (PPCs). Healthcare providers must comply with new mandatory reporting procedures and documentation standards when these events occur during patient care.
High impact
Maryland Medicaid: Balance billing is not permitted
UnitedHealthcare·Effective May 18, 2026
Maryland Medicaid providers are prohibited from balance billing members for any reason, including when charges exceed fee schedules, claims are denied, or during claim reviews. Providers must verify eligibility before services and can only collect permitted cost-sharing amounts.
Medium impact
Kentucky Medicaid outpatient therapy updates: What you need to know
UnitedHealthcare·Identified Jun 2, 2026
Kentucky Medicaid updated outpatient therapy prior authorization requirements under regulation 907 KAR 8:40. Medical necessity reviews now start at the 21st visit per discipline per calendar year, requiring initial evaluations, re-evaluations, and updated plans of care for authorization requests beyond 20 visits.
Low impact
Care Manager Kimberley S. is a “friend on the inside” for member and his family
Regence BlueCross BlueShield of Oregon·Identified Jun 2, 2026
This is a provider news article highlighting Regence's Care Management services, specifically profiling how Care Manager Kimberley S. supports complex cases. This is NOT a policy change affecting billing, coding, or reimbursement—it is informational content about an existing care management program available at no cost to members across Idaho, Oregon, Utah, and Washington.
High impact
[Virginia] June 2026 Provider Newsletter
Anthem BCBS·Effective Jun 1, 2026
This June 2026 Anthem Virginia provider newsletter contains multiple policy updates across administrative, clinical, and prior authorization areas. Key changes include Virginia prior authorization listing updates (effective June 1, 2026), parenteral nutrition prior authorization changes (effective July 1, 2026 for Medicare Advantage), and prior authorization requirement changes for multiple plan types (effective September 1, 2026). Billing teams must review specific updates for their affected plan types and implement corresponding workflow changes.
Medium impact
[California] Weekly authorization and denial log submission required for HMO risk providers — impacts claims accuracy and compliance
Anthem BCBS·Effective Jul 15, 2026
Anthem is implementing a new weekly authorization and denial log submission requirement for all HMO risk provider groups (Shared Risk, Dual Risk, and Full/Global Risk) in California, effective July 15, 2026. Provider groups must submit these logs via Anthem's secure EFX server to ensure accurate member cost sharing and claims processing. This requirement is separate from the existing annual Delegation Oversight Audit submission.
Low impact
[California] Direct HMO renamed Independent FFS Physicians: What you need to know
Anthem BCBS·Effective Jan 1, 2026
Effective January 1, 2026, Anthem Blue Cross renamed the 'Direct HMO' provider option to 'Independent FFS Physicians' in California. This is a name-only change with no impact on billing methodology, fee schedules, or network participation. Billing continues on an FFS basis using current PPO fee schedules, and referral requirements remain unchanged.
Medium impact
[New York] 2026 InterQual updates
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Anthem will transition to InterQual® 2026 criteria for psychological testing, neuropsychological testing, and developmental testing in New York. Billing teams must update clinical criteria references and prior authorization processes to align with the new 2026 InterQual guidelines.
Low impact
[New York] Making it easier for members to book with you: Anthem is partnering with ZocDoc in New York
Anthem BCBS·Effective Jun 1, 2026
Anthem Blue Cross is launching a ZocDoc integration within their Find Care platform in New York, allowing members to search and book appointments directly with participating providers. This is an administrative/operational change that does not affect billing codes, reimbursement, or clinical workflows—practices can optionally participate in the scheduling platform to reduce no-shows and administrative burden.
Medium impact
[Ohio] Ohio Medicaid Care Management Referral Form
Anthem BCBS·Effective Jun 1, 2026
Ohio Medicaid has released a new Case Management Referral Form for use by care providers referring members to Case Management or Continuity of Care services through Anthem Blue Cross and Blue Shield. Providers must complete and submit the form via email to OHPHCaseManagement@anthem.com to ensure timely member outreach and appropriate coordination of services.
Low impact
[Ohio] Invitation — Ohio Medicaid Provider Orientation
Anthem BCBS·Identified Jun 1, 2026
Anthem Ohio Medicaid is hosting a virtual provider orientation on June 25, 2026 to educate billing staff and providers on Ohio Medicaid business processes, including claims submission, prior authorization requirements, member eligibility, and billing best practices. This is an educational invitation with no policy changes affecting current billing workflows.
Medium impact
[Ohio] Avoid delays: LTC/custodial care authorization FAQs for MyCare Ohio care providers
Anthem BCBS·Effective Jun 1, 2026
Anthem MyCare Ohio has published FAQs clarifying prior authorization requirements for long-term care and custodial care services. Key points: LTC/custodial care authorizations approved for January 1, 2026 will be automatically extended through year-end (provided complete documentation was submitted); no retro authorizations are permitted; assisted living per diem (T2031) requires prior authorization; and all requests must be submitted via Availity Essentials or fax with complete clinical documentation, PASRR, and LOC forms.
Medium impact
[Virginia] Virginia prior authorizations listing update
Anthem BCBS·Effective Jun 1, 2026
Anthem Blue Cross Blue Shield Virginia has updated its prior authorization requirements effective June 1, 2026. Billing teams must access the updated precertification/prior authorization listings from Anthem's provider portal, with separate requirements documents for HMO/EPO plans versus other commercial plan types (PPO-style). The specific procedures requiring prior auth have changed and must be referenced from the updated documentation.
High impact
[Virginia] Authorization required for sick newborn DRG payment
Anthem BCBS·Effective Jun 1, 2026
HealthKeepers, Inc. (Virginia Medicaid) now requires valid sick newborn authorization on file before reimbursing inpatient newborn claims under sick newborn DRG. Claims submitted with sick newborn DRG but lacking required authorization will be automatically downgraded to well newborn DRG rates, resulting in reduced reimbursement.
High impact
BlueSpeak June 2026: Pharmacy Policy Updates
Blue Cross and Blue Shield of Kansas City·Effective Jul 1, 2026
Blue KC is implementing comprehensive pharmacy formulary updates across three commercial plan tiers (Premium, Select, and Essential Health Benefits) effective July 1, 2026. Changes include new prior authorization requirements for specific drugs, exclusions of certain medications with covered alternatives, exclusion of branded drugs with generic equivalents, and mandatory specialty pharmacy transition for three medications (Temozolomide, Fingolimod, Everolimus) through Lumicera Specialty Pharmacy.
High impact
Special Alert June 2026 - UPDATE Part 2 - Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes
Providence Health Plan·Effective Jun 1, 2026
Providence Health Plan implemented four coding and reimbursement policy changes effective June 1 and July 1, 2026: (1) rescinded the inpatient sepsis DRG length-of-stay edit; (2) will deny critical care services (99291/99292) billed in the ED when patients are discharged home; (3) will deny surgical procedures (CPT 10000-69999) missing required anatomical modifiers (RT, LT, E1-E4, etc.); and (4) will no longer reimburse additional units for anesthesia physical status modifiers P3, P4, P5 on commercial plans. These changes require immediate updates to billing logic, provider documentation requirements, and claim submission processes.
High impact
BlueSpeak Provider Newsletter — June 2026
Blue Cross and Blue Shield of Kansas City·Effective Jul 1, 2026
Blue KC issued multiple billing and coding updates effective July 1, 2026, with immediate preparation required. Key changes include: (1) Hemodialysis claims must now include Urea Reduction Ratio (URR) modifiers (G1-G6) on CPT 90999 or face automatic denial; (2) Joint replacement device C1776 is limited to 1 unit for shoulder/knee/hip replacements with stricter medical necessity documentation; (3) Chiropractic billing requires specific diagnosis codes matching each spinal region manipulated; (4) New radiology site-of-care policy may limit hospital-based imaging reimbursement. Additionally, maternity coding changes begin September 1, 2026, requiring E/M code modifications for prenatal visits.
High impact
BlueSpeak June 2026: Provider Education
Blue Cross and Blue Shield of Kansas City·Effective Jul 1, 2026
Blue KC issued a comprehensive provider education update addressing six key operational areas: (1) EOB submission requirements for secondary payer claims effective immediately, (2) risk adjustment documentation best practices to ensure accurate RAF scoring, (3) top 5 miscoding errors and fixes to reduce audit failures, (4) care gap closure initiatives, (5) new prepay audit requirements for claims exceeding $1M effective July 1, 2026, and (6) requirements to use the Claim Inquiry e-form and proper lab order submission procedures to avoid denials.
High impact
BlueSpeak June 2026: Medical policy updates
Blue Cross and Blue Shield of Kansas City·Effective Jul 1, 2026
BlueSpeak June 2026 introduces two new medical policies effective 7/1/2026: (1) Radiology Site of Care—advanced diagnostic imaging at hospital-based outpatient facilities may be denied if the service can be safely performed at a freestanding facility and site-of-care criteria are met; (2) Fractional CO2 Laser Ablation for Scars—treatment is medically necessary only when documented functional impairment exists, at least two other scar treatments have been trialed, and specific clinical criteria are met. Billing teams must implement prior authorization workflows and documentation requirements for both policies.
High impact
BlueSpeak June 2026: Payment Policy Updates
Blue Cross and Blue Shield of Kansas City·Effective Jul 1, 2026
Blue KC released three payment policy updates effective June-July 2026: (1) Chiropractic services now require diagnosis codes to support each spinal region manipulated with specific anatomical documentation; (2) Hemodialysis claims must include URR modifiers starting July 1, 2026 or face denial; (3) Joint replacement device billing (C1776) is limited to one unit for shoulder/knee/hip replacements effective July 1, 2026, with anchors/screws billed separately.
Medium impact
BlueSpeak June 2026: Obstetric Coding Changes
Blue Cross and Blue Shield of Kansas City·Identified Jun 1, 2026
Failed to analyze policy change
High impact
Medica Provider News: June 2026
Medica·Effective Jul 1, 2026
Medica is implementing multiple administrative changes effective June-September 2026: (1) Prime Therapeutics will manage all medical benefit drug prior authorizations starting July 1, 2026, requiring submission through Prime's portal instead of fax; (2) the secure provider portal will shut down September 1, 2026, with migration to Availity Essentials; (3) a new Provider Service Center telephony system launches in late June 2026; and (4) commercial drug formulary changes effective July 1, 2026. Billing teams must transition prior authorization workflows and update portal access procedures before these dates.
High impact
Jan. 1, 2026, PCA and CFSS reimbursement rates and wage floor retroactive payment requirements
Minnesota Medicaid (MHCP)·Effective Jan 1, 2026
Minnesota DHS has implemented new tiered minimum wage floors for Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) direct support workers, effective Jan. 1, 2026, with retroactive payment requirements. Providers must pay workers the enhanced minimum wages for all hours worked from Jan. 1, 2026 forward, and must make retroactive payments for hours already worked. New wage floor tiers were distributed to PCA Choice and FMS providers on May 28, 2026.
High impact
Physical Therapy (BSC8.03)
Blue Shield of California·Effective Jun 1, 2026
Blue Shield of California has updated their Physical Therapy policy (BSC8.03) effective June 1, 2026, establishing comprehensive medical necessity criteria for rehabilitative, maintenance, and habilitative PT services. The policy requires specific documentation of functional improvement, qualified practitioner delivery, and excludes services like back school, work hardening programs, and general fitness activities.

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Archive by year

2023 2024 2025 2026

New Jersey Medicaid: Discover new program for serious illness care

Massachusetts Medicaid: Reporting requirements for SREs and PPCs

Maryland Medicaid: Balance billing is not permitted

Kentucky Medicaid outpatient therapy updates: What you need to know

Care Manager Kimberley S. is a “friend on the inside” for member and his family

[Virginia] June 2026 Provider Newsletter

[California] Weekly authorization and denial log submission required for HMO risk providers — impacts claims accuracy and compliance

[California] Direct HMO renamed Independent FFS Physicians: What you need to know

[New York] 2026 InterQual updates

[New York] Making it easier for members to book with you: Anthem is partnering with ZocDoc in New York

[Ohio] Ohio Medicaid Care Management Referral Form

[Ohio] Invitation — Ohio Medicaid Provider Orientation

[Ohio] Avoid delays: LTC/custodial care authorization FAQs for MyCare Ohio care providers

[Virginia] Virginia prior authorizations listing update

[Virginia] Authorization required for sick newborn DRG payment

BlueSpeak June 2026: Pharmacy Policy Updates

Special Alert June 2026 - UPDATE Part 2 - Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes

BlueSpeak Provider Newsletter — June 2026

BlueSpeak June 2026: Provider Education

BlueSpeak June 2026: Medical policy updates

BlueSpeak June 2026: Payment Policy Updates

BlueSpeak June 2026: Obstetric Coding Changes

Medica Provider News: June 2026

Jan. 1, 2026, PCA and CFSS reimbursement rates and wage floor retroactive payment requirements

Physical Therapy (BSC8.03)