All Insurance Policy Changes (Page 1361)

Continuing from page 1360. 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
Massachusetts D-SNP updates: Senior Care Options, One Care members
UnitedHealthcare·Effective Jan 1, 2026
Massachusetts D-SNP members (Senior Care Options and One Care) now have new integrated subscriber IDs and policy numbers effective January 1, 2026. All prior authorizations under old IDs expired December 31, 2025, and claims spanning December 2025-January 2026 must be split using the appropriate subscriber ID for each date of service.
High impact
Georgia: Review key referral and billing protocols
UnitedHealthcare·Effective Feb 1, 2026
UnitedHealthcare Georgia has implemented new requirements for out-of-network referrals, balance billing protocols, and weight-loss medication prescriptions. Most significantly, only 9amHealth providers can now prescribe weight-loss medications for Georgia State Health Benefit Plan members in HMO/HDHP plans, effective February 1, 2026.
Medium impact
Florida Medicaid: New NEMT transportation vendor
UnitedHealthcare·Effective Mar 1, 2026
Starting March 1, 2026, MTM Health will manage all non-emergency medical transportation (NEMT) for UnitedHealthcare Community Plan of Florida Medicaid members. Members, facilities, and healthcare professionals should book rides through MTM Link online or call 888-777-6528.
High impact
Special Alert March 2026 - Outpatient Surgical Site of Service Notice
Providence Health Plan·Effective May 11, 2026
Effective May 11, 2026, Providence Health Plan will add medical necessity review for hospital outpatient site of service (place of service 22) for knee arthroscopy, shoulder arthroscopy, and small joint surgery procedures on commercial fully insured groups. If medical necessity criteria are not met for outpatient hospital setting, the procedure must be performed at an ASC for coverage. Prior authorization requirements remain unchanged for the procedures themselves, but now include site-of-service review.
High impact
Special Alert March 2026 - Implementation of Multiple Surgery Reduction (MSR) Rules for Endoscopic Procedures Billed by Ambulatory Surgery Centers (ASCs)
Providence Health Plan·Effective Mar 4, 2026
Effective March 4, 2026, Providence Health Plan is implementing Multiple Surgery Reduction (MSR) rules for endoscopic procedures billed by ASCs, aligning with CMS policy. When multiple endoscopies are performed, only the highest-valued procedure receives 100% reimbursement; subsequent procedures are paid at a reduced rate based on the difference from the base code. Endoscopies combined with non-endoscopic procedures follow standard 50% MSR rules.
Medium impact
Renal Denervation for Uncontrolled Hypertension (7.01.136)
Blue Shield of California·Effective Mar 1, 2026
Blue Shield of California now covers radiofrequency and ultrasound renal denervation procedures for uncontrolled hypertension when blood pressure remains above 130/80 mmHg despite 3+ antihypertensive medications from different classes. This represents a new coverage policy for specialized cardiovascular procedures effective March 1, 2026.
High impact
2026 March Network Connection
Presbyterian Health Plan·Effective Mar 13, 2026
Presbyterian is implementing Turquoise Claims, a new New Mexico Medicaid claims submission system going live March 23, 2026. Starting March 13, 2026, Presbyterian will stop creating secondary claims for dual-coverage members, requiring providers to submit both primary and secondary claims directly. Providers must use specific identifiers (Payor ID 77048, Loop 2010BB NMPHP) and verify member information against the HCA portal to ensure accurate claim payment.
Low impact
Tonic Motor Activation for Restless Legs Syndrome (1.01.32)
Blue Shield of California·Effective Mar 1, 2026
Blue Shield of California has established a new medical policy classifying Tonic Motor Activation (TOMAC) for restless legs syndrome as investigational and therefore not covered. This affects the NTX100 TOMAC System, a peroneal nerve stimulation device for patients with medication-refractory restless legs syndrome.
Medium impact
Medica Provider News: March 2026
Medica·Effective May 1, 2026
Effective May 1, 2026, Medica will remove medical benefit coverage for subcutaneous ustekinumab products. Coverage will shift to the pharmacy benefit for commercial, IFB, and integrated pharmacy/medical plans. Billing teams must identify affected claims, verify pharmacy benefit coverage with members' PBMs, and route claims to pharmacy instead of medical for SC ustekinumab on or after the effective date to prevent denials.
Medium impact
Updated Prior Authorization Criteria for Monoclonal Antibodies Effective April 1, 2026
Texas Medicaid·Effective Apr 1, 2026
Texas Medicaid is updating prior authorization criteria for two monoclonal antibody therapies effective April 1, 2026. Mepolizumab will now be covered for COPD treatment with specific eosinophilic and exacerbation requirements, while tezepelumab-ekko will be covered for chronic rhinosinusitis with nasal polyps. Both require detailed clinical documentation and prior authorization approval.
Medium impact
DME Procedure Codes E1033 and E1034 Now Benefits of the CSHCN Services Program
Texas Medicaid·Effective Apr 1, 2025
DME wheelchair parts procedure codes E1033 and E1034 are now covered benefits under the CSHCN Services Program effective April 1, 2025, with a reimbursement rate of $148.98 each. Prior authorization is mandatory for these codes - claims will be denied without it.
Low impact
Deadline Extended: Medicaid Advisory Committee Due: March 6, 2026
Texas Medicaid·Identified Feb 28, 2026
Texas Health and Human Services Commission is accepting applications for the Medicaid Advisory Committee (formerly Medical Care Advisory Committee) with an extended deadline of March 6, 2026. This is an opportunity for healthcare providers to influence Medicaid policies and services in Texas.
High impact
Reminder: STEPS Planned System Outage – Feb. 27, 2026 to March 1, 2026
Texas Medicaid·Effective Feb 27, 2026
The Texas STEPS system will be unavailable from February 27-March 1, 2026, preventing access to state Medicaid provider enrollment and payment programs. Multiple critical enrollment deadlines follow immediately after the system comes back online.
Low impact
Regional Offsite Review for Critical Incidents Management System Webinar Available for HCS/TxHmL Providers
Texas Medicaid·Identified Feb 28, 2026
HHSC has posted a pre-recorded webinar for Home and Community-based Services and Texas Home Living waiver program providers on critical incidents management processes, timelines, and requirements. This training is specifically for HCS/TxHmL providers and references provider letter 2024-22.
Medium impact
ALERT for QIPP Providers: Be Aware of Email Phishing Scam Falsely Using HHSC PFD Logo
Texas Medicaid·Identified Feb 27, 2026
HHSC is warning QIPP providers about phishing emails falsely using the HHSC Provider Finance Department logo, attempting to steal sensitive information by impersonating official communications about state fiscal year 2027 enrollment. Providers should not respond to emails from awashington@rootedschool.org requesting verification or threatening license suspension.
High impact
2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
Medicare/CMS·Effective Jan 1, 2026
CMS announced a major healthcare fraud crackdown including a nationwide moratorium on Medicare enrollment for certain DMEPOS suppliers and enhanced monitoring of MAC MBI lookup tools. Additionally, multiple billing updates are effective including new hypoglossal nerve neurostimulator codes, mandatory electronic CLIA certificates after March 1, and updated therapy service thresholds.
Medium impact
HHSC Publishes Payment Rates for Medicaid Community Hospice and Physician Services, Effective Retroactive to Oct. 1, 2025
Texas Medicaid·Effective Oct 1, 2025
HHSC has published new payment rates for Medicaid Community Hospice and Physician Services, effective retroactively to October 1, 2025. The approved rates are available in Information Letter 2026-05XX and on the HHSC Provider Finance Department website.
High impact
STEPS Planned System Outage – Feb. 27, 2026 to March 1, 2026
Texas Medicaid·Effective Feb 27, 2026
The State of Texas Electronic Provider System (STEPS) will be unavailable from February 27-March 1, 2026, for system upgrades. This outage affects multiple program enrollment deadlines immediately following the outage, including CHIRP, DPP BHS, RAPPS, and TIPPS programs with a March 5 deadline.
Low impact
Employment First Initiatives Webinar
Texas Medicaid·Effective Mar 18, 2026
Texas Health and Human Services Commission is hosting a free webinar on March 18 about Employment First initiatives to support people with disabilities in the workforce. This is an educational opportunity for healthcare providers to learn about programs that help waiver providers and community partners support disabled individuals in obtaining competitive employment.
Low impact
Reminder: EVV Survey Available through Feb. 28
Texas Medicaid·Identified Feb 26, 2026
HHSC is requesting EVV system users to complete a survey about the Electronic Visit Verification program to help improve procedures and prioritize updates. The survey is open through February 28 for various stakeholders including Medicaid recipients, providers, and CDS employers/employees.
Low impact
How Medical Policy at Regence works and why it matters for your health
Regence BlueCross BlueShield of Oregon·Identified Feb 26, 2026
Regence published an informational policy document explaining their medical policy framework and review process for coverage determinations. This is educational content about how Regence evaluates treatments for medical necessity, clinical effectiveness, and peer-reviewed research support. The document highlights recent policy decisions including declining coverage for emerging liver cancer and herniated disc treatments (insufficient evidence) and approving coverage for Nutcracker syndrome treatment (based on provider feedback). No specific billing code changes, coverage denials, or effective dates are specified in this announcement.
Low impact
Forbes Recognizes Blue Cross and Blue Shield of Alabama as One of America’s Best Employers 2026
Blue Cross Blue Shield of Alabama·Identified Feb 25, 2026
This is a press release announcing that Blue Cross and Blue Shield of Alabama has been recognized as one of America's Best Employers 2026 by Forbes. This is employer recognition news with no impact on billing policies, procedures, codes, coverage, or reimbursement.
High impact
Medical and Clinical Policy Updates - Winter 2026
Sentara Health Plans·Effective Feb 1, 2026
Sentara Health Plans released Winter 2026 medical policy updates affecting multiple service lines with staggered effective dates (February 1 and April 1, 2026). Key changes include archiving Medical 34 (Genetic and Molecular Testing) with routing to OncoHealth or Avalon authorization systems, revising policies for prescription digital therapeutics, orthotics/braces, lumbar laminectomy, and adopting Evolent 2026 Advanced Imaging Guidelines. Billing teams must implement new authorization workflows and update system configurations before effective dates.
Medium impact
Get eating disorder treatment at home with Equip
Regence BlueCross BlueShield of Oregon·Identified Feb 23, 2026
Regence has expanded virtual eating disorder treatment coverage through Equip, a specialized provider offering 100% virtual care with multidisciplinary teams (therapists, dietitians, medical providers, and mentors). This is available to most Regence members in ID, OR, UT, and WA with no waitlist, treating anorexia, bulimia, binge eating, ARFID, OSFED, and related co-occurring conditions. Billing teams should verify member eligibility and understand that Equip services are covered virtual behavioral health benefits.
High impact
Prior Authorization Changes to Oncology-related Codes
Highmark·Effective May 1, 2026
Effective May 1, 2026, Highmark is adding 115 oncology-related codes to their prior authorization requirement list, including common chemotherapy medications and radiation therapy procedures. All authorization requests for these codes must be submitted electronically through Availity Essentials and will be reviewed by Evolent as part of Highmark's oncology value-based care strategy.

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Archive by year

2023 2024 2025 2026

Massachusetts D-SNP updates: Senior Care Options, One Care members

Georgia: Review key referral and billing protocols

Florida Medicaid: New NEMT transportation vendor

Special Alert March 2026 - Outpatient Surgical Site of Service Notice

Special Alert March 2026 - Implementation of Multiple Surgery Reduction (MSR) Rules for Endoscopic Procedures Billed by Ambulatory Surgery Centers (ASCs)

Renal Denervation for Uncontrolled Hypertension (7.01.136)

2026 March Network Connection

Tonic Motor Activation for Restless Legs Syndrome (1.01.32)

Medica Provider News: March 2026

Updated Prior Authorization Criteria for Monoclonal Antibodies Effective April 1, 2026

DME Procedure Codes E1033 and E1034 Now Benefits of the CSHCN Services Program

Deadline Extended: Medicaid Advisory Committee Due: March 6, 2026

Reminder: STEPS Planned System Outage – Feb. 27, 2026 to March 1, 2026

Regional Offsite Review for Critical Incidents Management System Webinar Available for HCS/TxHmL Providers

ALERT for QIPP Providers: Be Aware of Email Phishing Scam Falsely Using HHSC PFD Logo

2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud

HHSC Publishes Payment Rates for Medicaid Community Hospice and Physician Services, Effective Retroactive to Oct. 1, 2025

STEPS Planned System Outage – Feb. 27, 2026 to March 1, 2026

Employment First Initiatives Webinar

Reminder: EVV Survey Available through Feb. 28

How Medical Policy at Regence works and why it matters for your health

Forbes Recognizes Blue Cross and Blue Shield of Alabama as One of America’s Best Employers 2026

Medical and Clinical Policy Updates - Winter 2026

Get eating disorder treatment at home with Equip

Prior Authorization Changes to Oncology-related Codes