All Insurance Policy Changes (Page 1353)

Continuing from page 1352. 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
New York Medicaid: No referrals needed for specialist visits
UnitedHealthcare·Effective Jan 1, 2026
Effective January 1, 2026, UnitedHealthcare Community Plan of New York no longer requires referrals for the first follow-up visit with 14 specialist categories within 7 days of emergency room or hospital discharge for Medicaid members. However, referrals are still required for any additional visits beyond the first follow-up.
Medium impact
New Jersey Medicaid: Fall risk screening in elderly patients
UnitedHealthcare·Identified Apr 1, 2026
The PDF content appears to be corrupted or unreadable, showing only technical PDF formatting data rather than actual policy content. Without readable policy text, the specific details about New Jersey Medicaid fall risk screening requirements cannot be determined.
Medium impact
New Jersey Medicaid: Billing our members for covered services is not permitted
UnitedHealthcare·Identified Apr 1, 2026
New Jersey Medicaid has issued a reminder that providers are prohibited from billing members directly for any covered services. This reinforces existing balance billing restrictions for NJ Medicaid members.
Medium impact
Michigan Medicaid: How to avoid denied community health worker claims
UnitedHealthcare·Identified Apr 1, 2026
Michigan FQHCs billing for community health worker (CHW) services must include specific required information on UB-04 forms to avoid claim denials. This includes modifier CG, attending and rendering NPIs, and Box 80 service descriptions, with specific rules for claim combining and qualifying visits.
High impact
Massachusetts Medicaid: Prior authorization, HCPCS coding and member ID updates
UnitedHealthcare·Effective Jan 1, 2026
Massachusetts Medicaid has updated prior authorization requirements for home health services in Senior Care Options and One Care plans, clarified that Medicare certified home health services do not require prior authorization, and specified required HCPCS G codes for different home health services. Additionally, some members have new subscriber identification numbers that must be verified to prevent claim rejections.
Medium impact
Remote Electrical Neuromodulation for Migraines (7.01.171)
Blue Shield of California·Effective Apr 1, 2026
Blue Shield of California updated their policy on Remote Electrical Neuromodulation (REN) devices like Nerivio for migraine treatment. The policy considers REN medically necessary for prevention in pediatric patients (8-17 years) and adults (18+) who meet specific headache frequency criteria, but adults must also fail 2+ medications from different drug classes first.
Medium impact
Noninvasive Fetal RHD Genotyping Using Cell-Free Fetal DNA (2.04.108)
Blue Shield of California·Effective Apr 1, 2026
Blue Shield of California updated their policy for noninvasive fetal RHD genotyping using cell-free DNA, clarifying coverage criteria and removing the discontinued SensiGene test from consideration. The policy covers testing when pregnancy is at risk for alloimmunization, paternal typing is unavailable/heterozygous, and amniocentesis is declined/contraindicated.
Low impact
Did You Know?
MVP Health Care·Effective Jun 1, 2026
MVP Healthcare clarifies that appeals notices should only be resubmitted if MVP specifically requests resubmission. The policy emphasizes avoiding duplicate faxes to prevent delays in the appeals process. This is an administrative reminder to optimize provider submission practices.
Medium impact
Self-Service Tools to Increase Efficiency
MVP Health Care·Effective Jun 1, 2026
MVP Healthcare has launched new self-service tools to streamline provider access to common information including prior authorization requirements, forms, and member/claim details. Providers can now use an Interactive Voice Response (IVR) system by calling 1-800-684-9286 to verify prior authorization needs and submit requests without representative assistance, with all interactions recorded in MVP systems.
High impact
Medical Policy Updates
MVP Health Care·Effective Feb 1, 2026
MVP Healthcare released comprehensive medical policy updates effective February 1, 2026 and April 1, 2026, covering 30+ clinical areas including new policies on peripheral nerve stimulators and peripheral nerve destruction/cryoablation, plus updates to existing coverage for bariatric surgery, gender affirming treatment, dental care, orthotic devices, chronic pain procedures, and multiple other services. The billing team must identify which policies affect your practice's service lines and implement corresponding coverage verification and prior authorization requirements.
Low impact
Mvp Living Well Programs For Your Patients
MVP Health Care·Identified Apr 1, 2026
MVP is promoting free virtual and in-person Living Well health and wellness programs available to all patients (MVP membership not required). This is an informational update for providers to educate patients about available wellness resources; no billing or clinical workflow changes are required.
Medium impact
Formulary Policy Updates
MVP Health Care·Identified Apr 1, 2026
MVP Healthcare has updated its 2026 Q2 formulary, removing 10 medications from prior authorization requirements across Commercial, Marketplace, and Self-Funded plans, excluding 4 new drugs from coverage, and adding 8 newly available generic equivalents. Billing teams must update prior authorization workflows to reflect these pharmacy coverage changes.
High impact
Medica Provider News: April 2026
Medica·Effective Jul 1, 2026
Effective July 1, 2026, Medica is transferring management of all medical benefit drug authorizations to Prime Therapeutics for specialty professionally administered drugs. Prior authorization requests must be submitted through Prime's Gateway portal instead of by fax to Medica. Additionally, CPT code 29826 (arthroscopic subacromial decompression) no longer requires prior authorization effective February 1, 2026.
Medium impact
Continuous Glucose Monitoring (1.01.20)
Blue Shield of California·Effective Apr 1, 2026
Blue Shield of California updated their Continuous Glucose Monitoring policy effective April 1, 2026, establishing specific medical necessity criteria for CGM coverage including requirements for insulin-dependent diabetes with 3+ daily insulin doses and devices with audible/tactile alarms. The policy also adds coverage criteria for implanted CGM devices and gestational diabetes monitoring.
Medium impact
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing (2.04.93)
Blue Shield of California·Effective Apr 1, 2026
Blue Shield of California updated their genetic cancer susceptibility panel testing policy, establishing specific criteria for when multigene panel testing is considered medically necessary versus investigational. The policy defines 'limited' panels (including only relevant gene variants for specific cancer indications) as potentially covered when criteria are met, while 'expanded' panels (including variants beyond Table PG1 or not recommended for the specific cancer type) are generally considered investigational.
Medium impact
Pharmacy Policy Updates
MVP Health Care·Identified Apr 1, 2026
Failed to analyze policy change
Medium impact
Legacy Health is asking for a bigger raise than Oregonians can afford
Regence BlueCross BlueShield of Oregon·Identified Apr 1, 2026
This is an opinion editorial from Regence regarding ongoing contract negotiations with Legacy Health in Oregon. Regence is resisting Legacy Health's requested rate increases, citing unsustainable pricing demands. While this does not announce a specific billing policy change, it signals potential contract termination risk and future reimbursement disputes that may affect claims processing and patient access.
High impact
Special Alert April 2026 - Alert for 6.1 Coding and Reimbursement Policy Changes
Providence Health Plan·Effective Jun 1, 2026
Providence Health Plan is implementing four new coding and reimbursement policies effective June 1, 2026: (1) denying sepsis DRG claims (871-872) with <3-day stays discharged to home; (2) denying critical care codes (99291-99292) billed in ED when discharged to home; (3) denying surgical procedures missing required anatomical modifiers; and (4) eliminating additional reimbursement units for anesthesia physical status modifiers P3, P4, P5 on commercial plans. These changes require immediate billing system updates and provider documentation reviews to prevent claim denials.
Medium impact
A Decade in Motion: CDPHP Cycle! Turns 10
CDPHP·Identified Apr 1, 2026
Failed to analyze policy change
Medium impact
2025 Annual Overviews highlight Regence’s community giving and stewardship of member dollars
Regence BlueCross BlueShield of Oregon·Identified Apr 1, 2026
Failed to analyze policy change
Low impact
Notice of Nondiscrimination
WellCare·Effective Nov 10, 2025
Wellcare has updated their annual Notice of Nondiscrimination policy, reaffirming their compliance with federal civil rights laws and providing non-discrimination notices in multiple languages for their Medicare Advantage and prescription drug plans. This is an informational update with no changes to billing procedures or coverage.
Low impact
Notice of Privacy Practices
WellCare·Effective Nov 10, 2025
Wellcare has updated their Notice of Privacy Practices document, which outlines how medical information may be used and disclosed for both Medicare Advantage and Prescription Drug Plan members. This is an administrative update to privacy policies rather than a billing or coverage change.
Low impact
Privacy Policy
WellCare·Identified Mar 31, 2026
This is Wellcare's updated Privacy Policy describing how they collect, use, and protect personal data through their digital properties and business interactions. This is an administrative policy change that does not affect billing procedures, codes, or clinical operations.
Low impact
Medicare Complaint Form
WellCare·Identified Mar 31, 2026
This policy update appears to be incomplete or corrupted, containing only website JavaScript code fragments rather than actual Medicare complaint form policy content. The provided content does not contain actionable billing guidance or policy changes.
Low impact
Submitting Medical Authorizations
WellCare·Identified Mar 31, 2026
This appears to be a webpage navigation header for Wellcare's medical authorization submission system rather than a substantive policy change. The content shows website navigation elements, footer information, and copyright text but contains no actual policy details or changes to authorization procedures.

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

New York Medicaid: No referrals needed for specialist visits

New Jersey Medicaid: Fall risk screening in elderly patients

New Jersey Medicaid: Billing our members for covered services is not permitted

Michigan Medicaid: How to avoid denied community health worker claims

Massachusetts Medicaid: Prior authorization, HCPCS coding and member ID updates

Remote Electrical Neuromodulation for Migraines (7.01.171)

Noninvasive Fetal RHD Genotyping Using Cell-Free Fetal DNA (2.04.108)

Did You Know?

Self-Service Tools to Increase Efficiency

Medical Policy Updates

Mvp Living Well Programs For Your Patients

Formulary Policy Updates

Medica Provider News: April 2026

Continuous Glucose Monitoring (1.01.20)

Genetic Cancer Susceptibility Panels Using Next Generation Sequencing (2.04.93)

Pharmacy Policy Updates

Legacy Health is asking for a bigger raise than Oregonians can afford

Special Alert April 2026 - Alert for 6.1 Coding and Reimbursement Policy Changes

A Decade in Motion: CDPHP Cycle! Turns 10

2025 Annual Overviews highlight Regence’s community giving and stewardship of member dollars

Notice of Nondiscrimination

Notice of Privacy Practices

Privacy Policy

Medicare Complaint Form

Submitting Medical Authorizations