All Insurance Policy Changes (Page 1324)

Continuing from page 1323. 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
[Georgia] Policy Updates - January 2026
CareSource·Effective Mar 1, 2026
CareSource Georgia Medicaid has revised its Readmission policy (AD-0978) effective March 1, 2026. The document provided is a notification of the policy update but does not contain specific details about what changed in the readmission policy itself. The billing team must access the full policy document to understand the specific requirements.
Medium impact
[Indiana] Pharmacy Policy Updates January 2026
CareSource·Effective Jan 1, 2026
CareSource Indiana Medicaid has updated pharmacy policies effective January 1, 2026, affecting 26 specialty medications across rare disease and specialty drug categories. This includes 3 new policy additions (Andembry, Ekterly, Sylvant, Yeztugo) and 22 revised policies for existing specialty drugs, plus 1 archived policy (Yutiq). Billing teams must review individual policy documents to identify specific prior authorization, coverage limitations, and documentation requirements for each medication.
Low impact
[Indiana] Policy Updates - January 2026
CareSource·Effective Mar 1, 2026
CareSource Indiana has issued a consolidated monthly policy update notification for January 2026. The document primarily references an administrative policy update (AD-0082: Electronic Data Interchange and Transactions, Revision 11/25/2025) effective March 1, 2026 for Indiana Medicaid. The full policy details are not included in this notification—providers must access the complete policy via CareSource's website to understand specific requirements.
Low impact
[Indiana] Save the Date: January 2026 Behavioral Health Live Orientation
CareSource·Identified May 9, 2026
This is a save-the-date announcement for a CareSource Indiana behavioral health provider orientation webinar scheduled for January 15, 2026. It is informational only and does not establish new billing policies, coverage changes, or clinical requirements affecting medical billing operations.
Low impact
[Indiana] Save the Date: January 2026 Live Provider Orientation
CareSource·Identified May 9, 2026
This is an informational bulletin announcing a live provider orientation event scheduled for January 22, 2026, tailored for newly contracted medical providers and healthcare facilities in Indiana. No policy changes, billing requirements, or operational directives are included—this is a save-the-date notification with registration details.
Medium impact
[Ohio] Policy Updates January 2026
CareSource·Effective Mar 1, 2026
CareSource Ohio Medicaid released a consolidated notification of 9 policy revisions effective March 1, 2026, spanning reimbursement, administrative, and medical policies. The document provides a directory of updated policies (Chiropractic Care, Dental Services, Non-Invasive Vascular Studies, Obstetrical Ultrasounds, Transcutaneous Electrical Nerve Stimulators, Coordination of Benefits, Behavioral Health Documentation, Epidural Steroid Injection, and Home Health Services) but does not detail the specific content changes within each policy.
High impact
[Ohio] 2026 Delta Dental Policies
CareSource·Effective Jan 1, 2026
CareSource and Delta Dental have implemented 28 new clinical criteria policies for dental services covering Ohio Medicaid and Ohio FIDE members, effective January 1, 2026. These policies establish clinical coverage criteria for specialty dental procedures including periodontal treatment, restorative work, prosthodontics, oral surgery, and endodontics. The billing team must review these policies to understand coverage requirements and apply them to claim submissions for affected Ohio Medicaid and FIDE beneficiaries.
High impact
[Ohio] Telehealth: Updates to the OAC Rule Effective Date January 1, 2026
CareSource·Effective Jan 1, 2026
Ohio Medicaid updated telehealth eligibility rules effective January 1, 2026, expanding eligible providers (adding doulas and lactation consultants) and eligible services (adding doula services, nurse home visiting, PrEP counseling, and EAPG codes). Billing requirements now mandate rendering provider NPI submission for all telehealth claims, and new telemedicine codes 98000-98016 should use POS 02/10 without GT or U modifiers.
Medium impact
[Ohio] January 7, 2026 Policy Updates
CareSource·Effective Feb 7, 2026
CareSource Ohio Medicaid is revising its Medical Policy MM-0034 regarding Interventions for Gender Dysphoria effective February 7, 2026. This is a revision to an existing policy, but the specific changes to coverage criteria, billing codes, or clinical guidelines are not detailed in this network notification document.
Low impact
[Georgia] Policy Updates February 2026 (2/2)
CareSource·Effective Apr 1, 2026
CareSource Georgia is announcing a consolidated monthly policy update notification process for Medicaid providers, with an administrative policy (AD-0711, GA-MED-P-4849350) effective April 1, 2026. The document itself is a network notification framework rather than a specific clinical or billing policy change, directing providers to access updated policies through CareSource's online portal.
High impact
[Georgia] Policy Updates February 2026 (1/2)
CareSource·Effective Apr 1, 2026
CareSource Georgia Medicaid is releasing 9 policy updates effective April 1, 2026, affecting medical policies (epidural steroid injections, spinal procedures, neonatal discharge), reimbursement policies (obstetrical care, pulse oximeter devices, influenza testing), and administrative policies (observational stay limits). One new policy (Pulse Oximeter Device-Non-Invasive, PY-1740) is being added. Billing teams must review each full policy document to identify specific code changes, prior authorization requirements, and coverage modifications before the effective date.
Medium impact
[Georgia] Pharmacy Policy Updates February 2026
CareSource·Effective Mar 1, 2026
CareSource Georgia Medicaid is implementing comprehensive pharmacy policy updates effective March 1, 2026, affecting 78 medications and therapeutic categories. This includes 11 new policies, 47 revised policies with potential clinical criteria changes, and 20 annual reviews with no clinical criteria updates. The billing team must review individual policy details for any prior authorization, coverage, or documentation requirement changes that may impact claim processing.
Medium impact
[Indiana] February 2026 Policy Updates
CareSource·Effective Apr 1, 2026
CareSource Indiana Medicaid is releasing six policy updates effective April 1, 2026 (one effective March 1, 2026), including new policies on Medical Necessity Determinations and Coding Guidelines, plus revisions to Clinical Trial Coverage, Pain Management Providers, Three-Day Window Payment, and Claims Editing and Review. Your billing team must review each policy on the CareSource website and implement corresponding workflow changes before the effective dates.
Low impact
[Indiana] Save the Date: February 2026 Behavioral Health Live Orientation
CareSource·Identified May 9, 2026
This is a save-the-date notification for a CareSource Indiana behavioral health provider orientation scheduled for February 19, 2026. It is informational only and does not contain policy changes affecting billing, coding, coverage, or reimbursement.
Medium impact
[Ohio] Policy Updates February 2026
CareSource·Effective Apr 1, 2026
CareSource Ohio Medicaid released six policy revisions effective April 1, 2026, affecting reimbursement (out-of-network payments, obstetrical unbundled costs), medical coverage (basivertebral nerve ablation, sacroiliac joint procedures, neonatal discharge criteria), and administrative processes (retrospective authorization review). Billing teams must review each full policy document to identify specific code and workflow impacts.
Low impact
[Ohio] Pharmacy Policy Updates February 2026
CareSource·Effective Mar 1, 2026
CareSource Ohio Medicaid is removing prior authorization requirements for YEZTUGO (lenacapavir), effective March 1, 2026. This HIV treatment medication will now be available without prior auth, streamlining the prescription approval process for Ohio Medicaid members.
Medium impact
[Georgia] Policy Updates (1/2) - March 2026
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid is implementing a revision to the Three-Day Window Payment policy (AD-0999) effective May 1, 2026. This administrative policy change affects how payments are processed for Georgia Medicaid claims. The full policy details are available on CareSource's provider portal and should be reviewed to determine specific billing workflow impacts.
Medium impact
[Georgia] Policy Updates (2/2) - March 2026
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid released three revised policies effective May 1, 2026: updates to EKG/ECG Interpretation and Imaging Interpretation (AD-1091), Trigger Point Injections (MM-0221), and Experimental or Investigational Item or Service (AD-0711). This is a policy notification document without specific billing code changes detailed; the actual policy revisions must be reviewed on the CareSource website to determine operational impacts.
Low impact
[Indiana] Save the Date: March 2026 Live Provider Orientation
CareSource·Identified May 9, 2026
This is a save-the-date announcement for an Indiana live provider orientation scheduled for March 19, 2026. The event is tailored for newly contracted medical providers and healthcare facilities and is informational only—no billing workflow changes are required.
Low impact
[Indiana] Save the Date: March 2026 Behavioral Health Live Orientation
CareSource·Identified May 9, 2026
This is a save-the-date announcement for a behavioral health provider orientation webinar scheduled for March 19, 2026 in Indiana. It is informational only and does not represent a policy change affecting billing, coding, or claims processing.
Medium impact
[Indiana] Policy Updates - March 2026
CareSource·Effective May 1, 2026
CareSource Indiana Medicaid has issued a monthly policy notification announcing two medical policy revisions effective May 1, 2026: updates to the Microwave Ablation of Tumors policy (MM-1482) and Non-Emergency Facility to Facility Transfers policy (MM-1446). The billing team must review the full policy text on CareSource.com to identify specific coverage, billing code, or authorization requirement changes.
Medium impact
[Indiana] Pharmacy Policy Updates - March 2026
CareSource·Effective May 1, 2026
CareSource Indiana Medicaid is updating pharmacy policies effective May 1, 2026, affecting 22 specialty medications. Four new medications (Brinsupri, Forzinity, Gazyva, Jascayd, Papzimeos) are being added to formulary with new policies, eight existing medications have revised policies (including Benlysta, Immune Globulin, Koselugo, Lupkynis, Nitisinone, Nplate, Qalsody, Saphnelo), and ten medications are undergoing annual reviews with no coverage changes. The billing team must review individual policy details for each revised and new drug to understand updated prior authorization requirements, dosing limits, or clinical criteria.
High impact
[Ohio] Policy Updates March 2026
CareSource·Effective May 1, 2026
CareSource Ohio Medicaid released a consolidated policy update notice for March 2026 containing 13 policy changes effective May 1, 2026. The updates span medical policies (breast reconstruction/reduction surgery, nerve blocks, trigger point injections, facet joint interventions, radiofrequency ablation), reimbursement policies (point of care testing, acupuncture, doula services, obstetrical care), and administrative policies (EKG interpretation, experimental/investigational services). Billing teams must review each individual policy document to identify specific code changes, coverage modifications, and documentation requirements.
Medium impact
[Ohio] Evolent Annual Guideline Updates March 2026
CareSource·Effective May 1, 2026
CareSource has updated 60+ advanced radiology service policies through its partnership with Evolent Healthcare, effective May 1, 2026. These annual guideline updates cover CT, MRI, CTA, MRA, PET, and specialty imaging procedures across Ohio Medicaid. The specific policy content changes are not detailed in this notification; providers must review updated policies on the Evolent website.
High impact
[Ohio] TurningPoint Annual Policies March 2026
CareSource·Effective May 1, 2026
CareSource/TurningPoint has updated 80 cardiac and musculoskeletal service policies (version .25) effective May 1, 2026 for both Ohio Medicaid and Ohio FIDE plans. This is an annual policy refresh covering procedures from implantable devices to joint replacements and spinal surgery. Billing teams must obtain and review the updated policy details at www.myturningpoint-healthcare.com to ensure compliance with any revised prior authorization requirements, coverage criteria, or documentation standards.

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Archive by year

2023 2024 2025 2026

[Georgia] Policy Updates - January 2026

[Indiana] Pharmacy Policy Updates January 2026

[Indiana] Policy Updates - January 2026

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

[Indiana] Save the Date: January 2026 Live Provider Orientation

[Ohio] Policy Updates January 2026

[Ohio] 2026 Delta Dental Policies

[Ohio] Telehealth: Updates to the OAC Rule Effective Date January 1, 2026

[Ohio] January 7, 2026 Policy Updates

[Georgia] Policy Updates February 2026 (2/2)

[Georgia] Policy Updates February 2026 (1/2)

[Georgia] Pharmacy Policy Updates February 2026

[Indiana] February 2026 Policy Updates

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

[Ohio] Policy Updates February 2026

[Ohio] Pharmacy Policy Updates February 2026

[Georgia] Policy Updates (1/2) - March 2026

[Georgia] Policy Updates (2/2) - March 2026

[Indiana] Save the Date: March 2026 Live Provider Orientation

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

[Indiana] Policy Updates - March 2026

[Indiana] Pharmacy Policy Updates - March 2026

[Ohio] Policy Updates March 2026

[Ohio] Evolent Annual Guideline Updates March 2026

[Ohio] TurningPoint Annual Policies March 2026