All Insurance Policy Changes (Page 1312)

Continuing from page 1311. 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
[Ohio] Doula services and coordination of benefits (COB)
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Ohio Medicaid (Anthem) is implementing Coordination of Benefits (COB) requirements for doula services. Doulas must now bill commercial insurance first before billing Medicaid, as federal rules require Medicaid to be the payer of last resort. This change aligns with recent commercial insurance coverage of doula services.
Medium impact
[Ohio] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, Carelon Medical Benefits Management is adding four radiation oncology CPT codes (77436, 77437, 77438, 77439) to their prior authorization requirement list for commercial plans in Ohio. Billing teams must begin obtaining precertification for these surface radiation therapy procedures through Carelon's provider portal or Availity before claims are submitted.
Medium impact
[Virginia] 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) for advanced coronary procedures now require precertification/prior authorization through Carelon Medical Benefits Management for Virginia Medicaid. Billing teams must implement these codes into their prior authorization workflows immediately.
Medium impact
[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listed
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Anthem will require 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) for Medicare Advantage members in Virginia. Prior authorization will be based on CMS LCD L38953 criteria, requiring documentation of a permanently nonfunctioning gastrointestinal tract. Claims submitted without prior authorization or that fail to meet medical necessity criteria will be denied.
Medium impact
[Virginia] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, CPT code 0253U (endometrial receptivity analysis for reproductive medicine) will require prior authorization through Carelon Medical Benefits Management for all Commercial and PPO plans in Virginia. Billing teams must update systems to mandate precertification requests before these genetic testing procedures are performed or billed.
Low impact
[Virginia] HEDIS provider resource material now available
Anthem BCBS·Effective Mar 30, 2026
Anthem Virginia has made HEDIS provider resource materials available through Availity Essentials Payer Spaces. These materials include coding guidance, documentation support, and measure-specific information for quality reporting. Billing and clinical teams should access and distribute these resources to ensure accurate HEDIS measure documentation and reporting.
Medium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, sleep neurostimulator code C1607 will require precertification/prior authorization through Carelon Medical Benefits Management for Medicare Advantage plans in Georgia. Billing teams must submit authorization requests via Carelon's provider portal or Availity before scheduling or billing for this implantable device.
Medium impact
[Georgia] Precertification/prior authorization change to the parenteral nutrition codes listed
Anthem BCBS·Effective Jul 1, 2026
Effective July 1, 2026, Anthem Blue Cross Blue Shield in Georgia is adding prior authorization requirements for 20 parenteral nutrition codes (HCPCS B-series and 5000/5100/5200 codes) under Medicare Advantage and Group Retiree plans. Claims that do not meet CMS LCD L38953 criteria (primarily requiring documentation of permanently nonfunctioning gastrointestinal tract) will be denied as ineligible for reimbursement.
Medium impact
[Georgia] 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) will require prior authorization/precertification through Carelon Medical Benefits Management for commercial plans in Georgia. Billing teams must implement this requirement in their authorization workflows and direct providers to submit requests through the Carelon provider portal or Availity.
Medium impact
OASIS for Clinicians Training Set for June
Texas Medicaid·Effective Jun 2, 2026
TMHP is offering mandatory OASIS-E2 training for registered nurses and therapists who collect OASIS data, with focus on the new All-Payer OASIS Reporting mandate effective July 1, 2025. This webinar covers foundational guidance and newest iQIES information including pre-survey reports.
Low impact
HHSC Roadshow Training: Announcing a NEW stop in Galveston, Texas! Mark your calendars for these upcoming stops!
Texas Medicaid·Identified May 27, 2026
HHSC is conducting roadshow training across Texas from June-August 2026, with a newly added stop in Galveston on July 8-9, 2026. The two-day in-person training focuses on Intellectual and Developmental Disability (IDD) programs including consumer directed services (CDS) option.
High impact
Improving the health care experience for providers and patients
Cigna·Identified May 27, 2026
Cigna Healthcare removed prior authorization requirements for 345 tests, procedures, and services (15% decrease) and enhanced their provider web portal to allow online PA submission, status checking, and documentation upload. They also expanded post-care claims advocacy support for complex situations.
Medium impact
Advance care planning and the important role of health care providers
Cigna·Effective May 26, 2026
Cigna Healthcare is emphasizing the importance of healthcare providers conducting advance care planning discussions with patients and properly documenting these conversations in medical records. This affects medical record review audits and quality program requirements.
Medium impact
Claim Review To Expand for Many Commercial Members
BCBS Texas·Effective Sep 1, 2026
Starting September 1, 2026, Blue Cross Blue Shield of Texas will expand prepayment claim review for commercial members on inpatient and outpatient claims of $50,000 or more. This enhanced review process will scrutinize provider coding against industry standards and may result in claim delays or denials if coding doesn't follow accepted payment policies.
Low impact
Change in Onboarding Process for New Providers, Effective Aug. 1, 2026
BCBS Texas·Effective Aug 1, 2026
Starting August 1, 2026, new providers joining the network must submit a W-9 form with both legal name and DBA name (if applicable), plus official IRS documentation (SS-4, 147C forms, or other IRS Tax ID notification) as part of their onboarding application. Current in-network providers are not affected unless there are organizational changes.
Medium impact
Cost reporting demo for DWRS and CFSS providers
Minnesota Medicaid (MHCP)·Identified May 27, 2026
The Minnesota Department of Human Services is offering mandatory demonstration webinars for providers selected for Disability Waiver Rates System (DWRS) and Community First Services and Supports (CFSS) cost reporting in 2026. Selected providers must attend one of the scheduled webinar sessions to learn how to complete required cost reporting submissions.
Low impact
CDPHP Ranked #1 in New York for Member Satisfaction in the JD Power 2026 U.S. Commercial Member Health Plan Study
CDPHP·Identified May 27, 2026
This is a press release announcing that CDPHP achieved #1 ranking in New York for member satisfaction by JD Power. This is organizational news, not a policy change affecting billing, coding, coverage, or reimbursement workflows.
High impact
Highmark’s Telehealth Policy Will Be Updated on Sept. 1
Highmark·Effective Sep 1, 2026
Effective Sept. 1, 2026, Highmark will restrict telehealth services to only those approved by CMS (nearly 300 CPT codes) and new AMA-approved E/M telehealth codes for audio-video (98000-98007) and audio-only (98008-98015) services. Services not on these approved lists will require in-person visits.
Medium impact
New and Updated Reimbursement Policies – May 2026
Highmark·Effective May 25, 2026
Highmark has issued multiple reimbursement policy updates with staggered effective dates from May through September 2026. Key changes include new care management codes, archived imaging criteria policies, updated skin substitute pricing, expanded rigid immobilization coverage, and revised telemedicine policies.
Medium impact
Update: Early Intensive Developmental Behavioral Intervention claim denials for Comprehensive Multi-disciplinary Evaluation (CMDE) services (CPT codes 97151 UB, H0046 UB, T1024 UB)
Minnesota Medicaid (MHCP)·Identified May 26, 2026
Minnesota Health Care Programs (MHCP) has resolved a system issue that was incorrectly denying Comprehensive Multi-disciplinary Evaluation (CMDE) claims for specific CPT codes when billed with pay-to provider types 01 or 34. MHCP will automatically reprocess affected claims; no action is required from providers at this time. Billing teams should monitor remittance advices for reprocessed claims.
Medium impact
How to Obtain Credentialing with Highmark Using the CertifyOS Platform
Highmark·Effective Aug 3, 2026
Effective August 3, 2026, Highmark Delaware is transitioning to the CertifyOS platform for all provider credentialing and recredentialing processes. Professional providers will continue using CAQH but will be redirected to CertifyOS, while organizational providers must use new CertifyOS applications directly.
Medium impact
Coverage of Healthcare Common Procedure Coding System "G2211": Add-On Code for Complex Pediatric Care
NY Medicaid·Identified May 24, 2026
New York State Medicaid now covers HCPCS code G2211 as an add-on code for complex pediatric care services. This policy is part of the April 2026 Medicaid Update and represents a new billing opportunity for pediatric providers treating complex cases.
Medium impact
Updates to Fee Schedules for Physician, Nurse Practitioner and Midwife Services
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid is updating fee schedules for physician, nurse practitioner, and midwife services. For obstetric care, providers must use E/M CPT codes with TH modifier and include Category II CPT code 0500F for initial prenatal visits for patients initiating care on/after June 1, 2026.
Medium impact
Submission of Secondary Claims to New York State Medicaid and Use of Claim Adjustment Reason Codes
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid now requires specific billing procedures for secondary claims and claim adjustment reason codes. For obstetric services, providers must use E/M CPT codes with TH modifier, pregnancy-related ICD-10 codes, and include Category II CPT code 0500F for initial prenatal visits when care initiates on/after June 1, 2026.
High impact
Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes
NY Medicaid·Effective Jun 1, 2026
Effective for prenatal care starting June 1, 2026, New York Medicaid requires providers to use E/M CPT codes with TH modifier, pregnancy-related O or Z ICD-10 codes for all prenatal visits, and Category II CPT code 0500F for initial prenatal visits. Current billing practices continue for established prenatal care until December 31, 2026.

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

[Ohio] Doula services and coordination of benefits (COB)

[Ohio] Prior authorization requirement updates — Carelon Medical Benefits Management

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

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

[Virginia] Prior authorization requirement updates — Carelon Medical Benefits Management

[Virginia] HEDIS provider resource material now available

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

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

[Georgia] Prior authorization requirement updates — Carelon Medical Benefits Management

OASIS for Clinicians Training Set for June

HHSC Roadshow Training: Announcing a NEW stop in Galveston, Texas! Mark your calendars for these upcoming stops!

Improving the health care experience for providers and patients

Advance care planning and the important role of health care providers

Claim Review To Expand for Many Commercial Members

Change in Onboarding Process for New Providers, Effective Aug. 1, 2026

Cost reporting demo for DWRS and CFSS providers

CDPHP Ranked #1 in New York for Member Satisfaction in the JD Power 2026 U.S. Commercial Member Health Plan Study

Highmark’s Telehealth Policy Will Be Updated on Sept. 1

New and Updated Reimbursement Policies – May 2026

Update: Early Intensive Developmental Behavioral Intervention claim denials for Comprehensive Multi-disciplinary Evaluation (CMDE) services (CPT codes 97151 UB, H0046 UB, T1024 UB)

How to Obtain Credentialing with Highmark Using the CertifyOS Platform

Coverage of Healthcare Common Procedure Coding System "G2211": Add-On Code for Complex Pediatric Care

Updates to Fee Schedules for Physician, Nurse Practitioner and Midwife Services

Submission of Secondary Claims to New York State Medicaid and Use of Claim Adjustment Reason Codes

Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes