All Insurance Policy Changes (Page 1311)

Continuing from page 1310. 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
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (June 2026 Newsletter)
Anthem BCBS·Effective Sep 1, 2026
Carelon Medical Benefits Management has updated prior authorization and precertification requirements across multiple service categories effective September 1, 2026 (Medicare Advantage) and October 1, 2026 (Commercial). Changes affect cardiovascular, genetic testing, sleep medicine, radiation oncology, radiology, musculoskeletal, and other specialties. Note: One cardiovascular policy was retracted on July 17, 2026.
Low impact
[Georgia] Required 2026 Model of Care Training Now Available
Anthem BCBS·Identified May 28, 2026
Anthem Blue Cross Blue Shield is announcing that required 2026 Model of Care training is now available for all contracted providers participating in Medicare Advantage Special Needs Plans (SNPs) in Georgia. This is an annual CMS-mandated training covering SNP programs, cost sharing, data sharing, Interdisciplinary Care Team participation, and member care coordination. Provider participation is required to maintain compliance and support quality outcomes.
Low impact
June 10 Quarterly Nursing Facility Webinar with HHSC LTCR
Texas Medicaid·Effective Jun 10, 2025
HHSC Long-Term Care Regulation is hosting a mandatory nursing facility provider webinar on June 10, 2025, covering critical updates including IJs, disease outbreaks, PASRR updates, and MDS updates. Provider attendance is described as critical to stay current with requirements and guidance.
Medium impact
June 2026 newsletter
Aetna·Effective Sep 1, 2026
Aetna's June 2026 newsletter announces multiple changes: new claim edits starting September 1, 2026, a 15% payment reduction for radiology services with modifier CT effective September 1, 2026, and updated commercial drug lists effective October 1, 2026.
Medium impact
2026-05-28 - PEPPER Relaunch for All Facility Types: Get Ready Now
Medicare/CMS·Identified May 28, 2026
CMS is relaunching the PEPPER (Program for Evaluating Payment Patterns Electronic Report) tool for all Medicare facility types to help identify billing patterns and potential compliance issues. Healthcare facilities need to ensure authorized staff have access through the CMS Identity & Access System to download and review their organization's billing data reports.
Low impact
Five Stars: Health Net Recognized by USA TODAY for Customer Service; Only California-Based Health Insurer Recognized with Highest Rating
Centene·Identified May 27, 2026
Health Net has been recognized by USA TODAY for exceptional customer service in 2026. This is a press release announcing an award and does not contain any policy changes affecting billing, coding, or reimbursement procedures.
Medium impact
[California] Manage physical health P2P conversations online — mid‑June
Anthem BCBS·Effective Jul 15, 2026
Anthem Blue Cross California is launching an online Peer-to-Peer (P2P) scheduling enhancement on the Availity Essentials platform, allowing providers to schedule and cancel P2P conversations electronically 24/7 for physical health and behavioral health services. This replaces the current phone/email submission process and is designed to reduce administrative burden and improve scheduling efficiency.
Medium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, HCPCS code C1607 (Neurostimulator, integrated implantable rechargeable) now requires precertification/prior authorization through Carelon Medical Benefits Management for all California PPO plans. Billing teams must implement prior auth requirements in their systems and ensure providers submit authorization requests before scheduling or performing this procedure.
Medium impact
[California] Precertification/prior authorization change to the parenteral nutrition codes listed
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Anthem Blue Cross will require precertification/prior authorization for 20 parenteral nutrition codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) for Medicare Advantage members in California. Claims lacking prior authorization or not meeting CMS LCD L38953 criteria (permanently nonfunctioning gastrointestinal tract) will be denied.
Medium impact
[California] New provider manual now available
Anthem BCBS·Effective Jan 1, 2026
Anthem has released a revised Provider Manual (effective January 1, 2026) that clarifies Medicare Advantage peer-to-peer review processes in alignment with new CMS guidance. Key change: all coverage decisions must include proper member notification and appeal rights that cannot be bypassed. Pre-decision peer-to-peer discussions are still permitted when time allows, but post-decision discussions are informational only and do not affect coverage decisions or timelines.
High impact
[New York] Medical Policies and Clinical Utilization Management Guidelines update
Anthem BCBS·Effective Jun 19, 2026
Anthem Medicaid in New York is updating multiple medical policies and clinical utilization management guidelines effective June 19, 2026. These revisions affect prior authorization requirements, coverage criteria, and medical necessity determinations across diverse service categories including gene therapy, cosmetic/reconstructive services, durable medical equipment, transplantation, bariatric surgery, and sleep testing. Some previously covered services may now be found not medically necessary under the revised criteria.
Medium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Carelon Medical Benefits Management requires prior authorization for four specific cardiovascular procedures (CPT codes C7568, C7569, C7570, C7571) for New York Medicaid and commercial plans. Ordering and servicing providers must submit precertification requests through Carelon's provider portal, Availity Essentials, or email before performing these coronary catheterization and angioplasty procedures.
High impact
[New York] Precertification/prior authorization change to the parenteral nutrition codes listed
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Anthem Medicare Advantage plans in New York will require prior authorization for 20 parenteral nutrition-related HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200). Prior authorization must be obtained before dispensing to avoid claim denials. Services must meet CMS LCD L38953 criteria, requiring documentation of a permanently nonfunctioning gastrointestinal tract.
Medium impact
[New York] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, CPT code 0253U (reproductive medicine endometrial receptivity analysis) now requires prior authorization through Carelon Medical Benefits Management for commercial plans in New York. Billing teams must implement this requirement in their workflows and direct providers to submit authorization requests via the Carelon provider portal or Availity Essentials before services are rendered.
Medium impact
[New York] Additional information for your 835 electronic remittance advice
Anthem BCBS·Effective Mar 14, 2026
Effective March 14, 2026, Anthem's 835 Electronic Remittance Advice (ERA) for New York commercial claims will display both the submitted procedure code and the adjudicated (allowable) procedure code on service lines. This change applies only to inclusive (non-separately payable) services and helps billing teams identify which allowable service the bundled line is associated with for improved reconciliation.
Low impact
[New York] HEDIS provider resource material now available
Anthem BCBS·Effective Mar 30, 2026
Anthem Blue Cross and Blue Shield has made HEDIS provider resource materials available through Availity Payer Spaces for New York providers. These educational resources include coding guidance, documentation support, and measure-specific information to help providers with accurate HEDIS reporting and compliance. Billing and clinical teams should access and distribute these materials to ensure proper documentation and coding practices.
Low impact
[New York] Medication adherence: a silent epidemic
Anthem BCBS·Identified May 27, 2026
This is an informational provider bulletin from Anthem Blue Cross Blue Shield (New York) regarding medication adherence best practices for Medicare Advantage members. It outlines evidence-based strategies to improve medication adherence, such as normalizing adherence conversations, extending days' supply to 90 days, using Real-Time Prescription Benefit tools, and implementing home delivery programs. No specific billing code changes, prior authorization requirements, or coverage modifications are announced.
Medium impact
[New York] Submit corrected claims electronically for the Federal Employee Program®
Anthem BCBS·Effective Mar 30, 2026
Anthem Blue Cross and Blue Shield is promoting electronic submission of corrected claims for Federal Employee Program (FEP) members through Availity Essentials or EDI. Providers must use specific frequency codes (6, 7, or 8 for professional claims; 0XX6, 0XX7, or 0XX8 for institutional claims) and include the payer control number from the original claim to indicate corrections, replacements, or voids of previously adjudicated claims.
Medium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, four new cardiovascular CPT codes (C7568, C7569, C7570, C7571) related to coronary angiography and angioplasty procedures now require precertification/prior authorization through Carelon Medical Benefits Management for Ohio Medicaid beneficiaries. Providers must obtain authorization before performing these procedures or face potential claim denials.
Medium impact
[Ohio] Precertification/prior authorization change to the parenteral nutrition codes listed
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Anthem Medicare Advantage plans in Ohio will require precertification/prior authorization for 20 parenteral nutrition HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) aligned with CMS LCD L38953. Claims lacking prior authorization approval may be denied as ineligible for payment.
High impact
[Ohio] OH Medicaid Doula claim submission FAQ
Anthem BCBS·Effective Apr 1, 2026
Ohio Medicaid has established a comprehensive FAQ for doula service claim submission effective April 1, 2026. Claims must be submitted electronically via EDI through an approved trading partner or via Availity Essentials Direct Data Entry; paper claims are no longer accepted. Billing teams must use specific HCPCS codes (T1032, T1033, T1023) with designated diagnosis codes (Z32.2, Z32.3) and append the GT modifier for telehealth services.
Low impact
[Ohio] New Availity Essentials features for out‑of‑network providers
Anthem BCBS·Effective Apr 15, 2026
Anthem has launched new self-service features in Availity Essentials for out-of-network providers in Ohio, including a streamlined registration process for out-of-network provider registration. Out-of-network providers can now proactively register their organizations through the platform to facilitate single case agreements, service authorizations, and improve claims processing efficiency.
High impact
[Ohio] Next Generation MyCare quick reference guide
Anthem BCBS·Effective Jan 1, 2026
Ohio MyCare Next Generation program launches in phases starting January 1, 2026, beginning with 29 counties where MyCare Ohio currently operates. Billing teams must implement new claims submission workflows for dual-eligible and Medicaid-only members, including new EDI payer ID (0022147) and different routing procedures based on member's primary Medicare coverage.
Medium impact
[Ohio] State communication: Ohio Department of Medicaid Telehealth Guidelines
Anthem BCBS·Effective Jan 1, 2026
The Ohio Department of Medicaid has issued updated telehealth guidelines effective January 1, 2026. The specific policy details are contained in a referenced PDF document that is not fully displayed in this communication. Billing teams must review the complete PDF guidelines to understand any changes to telehealth coverage, billing, or documentation requirements for Ohio Medicaid and MyCare Ohio beneficiaries.
Low impact
[Ohio] Long-term services and supports (LTSS): Virtual Provider Office Hours
Anthem BCBS·Effective Jun 1, 2026
Anthem MyCare Ohio is offering weekly virtual office hours for Long-Term Services and Supports (LTSS) providers, with separate sessions for independent providers (Mondays 11 AM-12 PM ET) and agency providers (Mondays 3-4 PM ET). Registration is one-time only and provides access to recurring meeting series. This is an informational bulletin about provider support resources, not a billing or coverage policy change.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (June 2026 Newsletter)

[Georgia] Required 2026 Model of Care Training Now Available

June 10 Quarterly Nursing Facility Webinar with HHSC LTCR

June 2026 newsletter

2026-05-28 - PEPPER Relaunch for All Facility Types: Get Ready Now

Five Stars: Health Net Recognized by USA TODAY for Customer Service; Only California-Based Health Insurer Recognized with Highest Rating

[California] Manage physical health P2P conversations online — mid‑June

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

[California] Precertification/prior authorization change to the parenteral nutrition codes listed

[California] New provider manual now available

[New York] Medical Policies and Clinical Utilization Management Guidelines update

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

[New York] Precertification/prior authorization change to the parenteral nutrition codes listed

[New York] Prior authorization requirement updates — Carelon Medical Benefits Management

[New York] Additional information for your 835 electronic remittance advice

[New York] HEDIS provider resource material now available

[New York] Medication adherence: a silent epidemic

[New York] Submit corrected claims electronically for the Federal Employee Program®

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

[Ohio] Precertification/prior authorization change to the parenteral nutrition codes listed

[Ohio] OH Medicaid Doula claim submission FAQ

[Ohio] New Availity Essentials features for out‑of‑network providers

[Ohio] Next Generation MyCare quick reference guide

[Ohio] State communication: Ohio Department of Medicaid Telehealth Guidelines

[Ohio] Long-term services and supports (LTSS): Virtual Provider Office Hours