All Insurance Policy Changes (Page 1325)

Continuing from page 1324. 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] Delta Dental Policy Updates March 2026
CareSource·Effective Mar 1, 2026
CareSource has partnered with Delta Dental to update clinical policies for dental services covering Ohio Medicaid and Ohio FIDE members. Policy 282.24 regarding Clinical Criteria for Extraction of Teeth has been revised and is effective March 1, 2026. Billing teams must review the updated extraction criteria on the Delta Dental website to ensure compliance with new clinical guidelines.
Medium impact
[Ohio] Pharmacy Policy Updates March 2026
CareSource·Effective Apr 1, 2026
CareSource Ohio Medicaid is updating pharmacy policies for 10 medications effective April 1, 2026. Eight policies are revisions to existing coverage/prior authorization requirements, and two are new policies (Gazyva and Palsonify). Billing teams must review each medication's specific policy requirements to ensure accurate prior authorization submission and claim processing.
Medium impact
[Georgia] April 2026 Pharmacy Policy Updates (6/6)
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid has archived the YUTIQ (Fluocinolone Acetonide) pharmacy policy effective May 1, 2026. This notification indicates the policy is no longer active; billing teams must verify current coverage status and prior authorization requirements with CareSource before dispensing or billing for this medication.
Medium impact
[Georgia] April 2026 Pharmacy Policy Updates (5/6)
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid is updating pharmacy policies for 10 medications effective May 1, 2026. Nine drugs have revised policies requiring billing team review, while one (Aubagio/teriflunomide) and one (Berinert/C1 esterase inhibitor) underwent annual review with no changes. Specific policy details are not provided in this notification document.
Medium impact
[Georgia] April 2026 Pharmacy Policy Updates (4/6)
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid is updating pharmacy policies for 10 medications effective May 1, 2026. Most policies are revised (APRETUDE, BAFIERTAM, CINRYZE, DAYBUE, DOPTELET, ELEVIDYS, EMPAVELI, ENTYVIO), while two undergo annual review with no updates (AUBAGIO, BERINERT). Billing teams must review individual policy documents for specific coverage criteria, prior authorization requirements, and any changes to reimbursement or documentation standards.
Medium impact
[Georgia] April 2026 Pharmacy Policy Updates (3/6)
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid is updating pharmacy policies for 10 medications effective May 1, 2026. Nine drugs have revised policies (Cimzia, Egrifta SV/WR, inhaled prostacyclins, Leqselvi, Litfulo, Olumiant, Skyrizi, Tremfya, and Xeljanz/Xeljanz XR), while Sylvant is a new policy addition. Billing teams must review the full policy details on CareSource.com to understand specific coverage, prior authorization, and billing requirements for each medication.
Medium impact
[Georgia] April 2026 Pharmacy Policy Updates (2/6)
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid is revising pharmacy policies for 10 specialty medications effective May 1, 2026. These are revised policies (not new) affecting biologics and specialty drugs including AJOVY, DUPIXENT, GAMIFANT, IMMUNE GLOBULIN, KISUNLA, NITISINONE, NUCALA, OTEZLA, RIVFLOZA, and SKYTROFA. The document provides notice of the changes but does not specify what was revised in the policies themselves.
Medium impact
[Georgia] April 2026 Pharmacy Policy Updates (1/6)
CareSource·Effective May 1, 2026
CareSource Georgia Medicaid is releasing 10 pharmacy policy updates effective May 1, 2026, including 5 new policies (Adalimumab, Andembry, Ekterly, Sephience, Yeztugo) and 5 revised policies (Gender Identity Hormone Therapy, Hemophilia and Other Clotting Disorders, Mavyret, Ustekinumab, Zeposia). Billing teams must review each policy to understand prior authorization requirements, coverage criteria, and any documentation changes for these medications.
Low impact
[Indiana] Save the Date: April 2026 Live Behavioral Health Provider Orientation
CareSource·Identified May 9, 2026
This is a save-the-date notification for a live behavioral health provider orientation scheduled for April 23, 2026, tailored for newly contracted behavioral health providers and care facilities in Indiana. No billing policy changes, coverage modifications, or billing code updates are included in this document.
Low impact
[Indiana] Save the Date: April 2026 Live Medical Provider Orientation
CareSource·Identified May 9, 2026
This is a save-the-date notification for a live medical provider orientation scheduled for April 16, 2026, tailored for newly contracted medical providers and healthcare facilities in Indiana. This is an informational bulletin announcing an upcoming educational event, not a policy change affecting billing, coding, or claims processing.
Medium impact
[Indiana] Policy Updates April 2026
CareSource·Effective Jun 1, 2026
CareSource Indiana Medicaid released three policy revisions effective June 1, 2026: updates to Inhaled Nitric Oxide coverage (MM-1186), Interest Payments reimbursement procedures (PY-1325), and EKG/ECG interpretation guidelines (AD-1092). This is a notification document listing policy changes; the specific clinical and billing impacts require review of the individual full policy documents.
Medium impact
[Ohio] April 2026 Policy Updates
CareSource·Effective Jun 1, 2026
CareSource Ohio Medicaid released 10 policy updates effective June 1, 2026, including revisions to medical policies (nerve stimulators, bariatric surgery, adaptive seating, standing frames, genetic testing, mechanical stretching devices, and transcranial magnetic stimulation), one new administrative policy (speech generating devices), and two reimbursement policy revisions (modifier 26/TC components and dental procedures in facility settings). Billing teams must review each linked policy for specific coverage, documentation, and billing requirements before the effective date.
Medium impact
[Georgia] May 2026 Policy Updates
CareSource·Effective Jul 1, 2026
CareSource Georgia Medicaid is releasing four policy updates effective July 1, 2026, including revisions to Medical Necessity Determinations, Metabolic and Bariatric Surgery coverage, Metabolic and Bariatric Surgery Revision criteria, and Inhaled Nitric Oxide coverage. This is a consolidated notification of administrative and medical policy changes; specific billing impacts require review of the individual policy documents.
Medium impact
[Georgia] May 2026 Medical and Administrative Policy Updates
CareSource·Effective Jul 1, 2026
CareSource Georgia Medicaid is updating four policies effective July 1, 2026: revising Genetic Testing and Counseling (MM-0735), Mechanical Stretching Devices (MM-1381), and Provider Prepayment Review (AD-1437), plus adding a new Speech Generating Devices policy (AD-1622). Billing teams must review each policy detail on the CareSource website to identify specific coverage, coding, or documentation changes that may affect claims submission.
Medium impact
[Georgia] May 2026 Reimbursement Policy Updates
CareSource·Effective Jul 1, 2026
CareSource Georgia Medicaid is releasing two reimbursement policy updates effective July 1, 2026: a NEW policy on Evaluation and Management (E/M) and Psychotherapy (PY-1767) and a REVISED policy on Evaluation and Management Services and Urinalysis (PY-1605). The billing team must review the full policy text to understand specific code changes, reimbursement adjustments, or documentation requirements that may affect claim submission and payment.
Medium impact
[Georgia] May 2026 Pharmacy Policy Updates
CareSource·Effective Jun 1, 2026
CareSource Georgia Medicaid has updated pharmacy policies for 10 medications effective June 1, 2026. Nine medications have revised policies (Fingolimod, Somatropin, Simponi, Skyclarys, Sogroya, Tavalisse, Tecfidera, Velsipity, and Vumerity), while one medication (Takhzyro) underwent annual review with no updates. The billing team must review the revised policy details on the CareSource provider portal to identify any changes to prior authorization requirements, coverage criteria, or reimbursement for these specialty pharmaceuticals.
Low impact
[Indiana] Save the Date: May 2026 Live Provider Orientation
CareSource·Identified May 9, 2026
This is a save-the-date notification for an Indiana provider orientation webinar scheduled for May 21, 2026. The event is tailored for newly contracted medical providers and healthcare facilities. No billing, coding, or coverage changes are being implemented.
Low impact
[Indiana] Save the Date: May 2026 Behavioral Health Live Orientation
CareSource·Identified May 9, 2026
This is a save-the-date notification for a Behavioral Health Live Orientation webinar scheduled for May 14, 2026, tailored for newly contracted behavioral health providers and care facilities in Indiana. No billing, coverage, or coding changes are announced; this is purely an informational event notice.
Medium impact
[Indiana] Policy Updates May 2026
CareSource·Effective Jul 1, 2026
CareSource Indiana Medicaid released policy updates effective July 1, 2026, including revisions to Non-Invasive Vascular Studies (AD-1120) and Evaluation and Management Services and Urinalysis (PY-1606). The billing team must review the full policy text to identify specific code and reimbursement changes, as this notification only lists policy titles without detailing the actual revisions.
Medium impact
[Indiana] Pharmacy Policy Updates May 2026
CareSource·Effective Jul 1, 2026
CareSource Indiana Medicaid is updating 20 pharmacy policies effective July 1, 2026, including 6 new drug policies (AQVESME, EXDENSUR, KYGEVVI, LEROCHOL, MYQORZO, REDEMPLO, WASKYRA), 9 revised policies with updated clinical criteria, 2 archived policies (340B DRUG PRICING, KUVAN), and 3 policies with annual reviews but no clinical changes. The billing team must review each specific policy on CareSource.com to identify any prior authorization, coverage restrictions, or documentation requirements that may affect claim processing.
High impact
[Ohio] May 2026 Policy Updates
CareSource·Effective Jul 1, 2026
CareSource Ohio Medicaid released 12 policy updates effective July 1, 2026, affecting medical coverage (airway devices, wound therapy, continence therapy), administrative processes (cystic fibrosis testing, provider reviews, readmissions), and reimbursement rules (E/M visit bundling, modifier usage, temporary codes, obstetrical care). The billing team must review each policy and implement necessary changes to coding, prior authorization, and documentation requirements before the July 1 effective date.
Low impact
[Ohio] Provider Portal Registration Guide
CareSource·Identified May 9, 2026
CareSource has released a new provider portal registration guide for Ohio providers. This appears to be an administrative guide to help providers register for or use CareSource's provider portal system.
Medium impact
[Ohio] Notice to Home Health Agencies Regarding License Renewal Grace Period
CareSource·Effective Feb 1, 2026
Ohio Department of Health is granting a one-time grace period for Home Health Agencies (HHAs) whose licenses were due for renewal between July 31, 2025, and January 31, 2026. These agencies have until February 1, 2026, to file for renewal, with licenses remaining active as of their original expiration date. After February 1, 2026, any HHA failing to renew timely must restart the licensing process by applying for a new initial license.
High impact
[Ohio] Prepay Auditing Update
CareSource·Effective Mar 2, 2026
CareSource is implementing enhanced prepay claims auditing effective March 2, 2026, requiring providers to submit medical records for claims flagged with reason codes BB1 or PJR. Claims will not be paid until medical records are received and reviewed for compliance with CMS, AMA, and AHA coding guidelines; records must be submitted within 365 days or claims remain denied.
Medium impact
[Ohio] Updates to the OAC Rule 5160-8-52 Pharmacist Services
CareSource·Effective Jan 1, 2026
Ohio Medicaid (CareSource) now allows separate billing and payment for pharmacist services provided in hospital settings (inpatient, outpatient, emergency department, and inpatient psychiatric facilities). The previous policy prohibiting separate payment for these services has been rescinded effective January 1, 2026. Healthcare practices can now bill pharmacist services at the individual pharmacist level or hospital facility level.

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] Delta Dental Policy Updates March 2026

[Ohio] Pharmacy Policy Updates March 2026

[Georgia] April 2026 Pharmacy Policy Updates (6/6)

[Georgia] April 2026 Pharmacy Policy Updates (5/6)

[Georgia] April 2026 Pharmacy Policy Updates (4/6)

[Georgia] April 2026 Pharmacy Policy Updates (3/6)

[Georgia] April 2026 Pharmacy Policy Updates (2/6)

[Georgia] April 2026 Pharmacy Policy Updates (1/6)

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

[Indiana] Save the Date: April 2026 Live Medical Provider Orientation

[Indiana] Policy Updates April 2026

[Ohio] April 2026 Policy Updates

[Georgia] May 2026 Policy Updates

[Georgia] May 2026 Medical and Administrative Policy Updates

[Georgia] May 2026 Reimbursement Policy Updates

[Georgia] May 2026 Pharmacy Policy Updates

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

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

[Indiana] Policy Updates May 2026

[Indiana] Pharmacy Policy Updates May 2026

[Ohio] May 2026 Policy Updates

[Ohio] Provider Portal Registration Guide

[Ohio] Notice to Home Health Agencies Regarding License Renewal Grace Period

[Ohio] Prepay Auditing Update

[Ohio] Updates to the OAC Rule 5160-8-52 Pharmacist Services