All Insurance Policy Changes (Page 1362)

Continuing from page 1361. 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
MSK Authorization Will Transition from eviCore to Highmark on May 1, 2026
Highmark·Effective May 1, 2026
Effective May 1, 2026, Highmark is taking over musculoskeletal (MSK) and interventional pain management authorization requests from eviCore. Providers must submit all MSK and IPM authorization requests through Availity Essentials portal using Highmark's new AuthAI tool for faster processing.
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.
Low impact
Over 2800 Children Running in the Blue Cross and Blue Shield of Alabama 2026 Kids Marathon
Blue Cross Blue Shield of Alabama·Identified Feb 23, 2026
This is a community health event announcement from Blue Cross and Blue Shield of Alabama promoting a kids marathon scheduled for February 21, 2026. This is not a policy change affecting billing, coverage, reimbursement, or medical services and requires no billing team action.
Medium impact
Updated Pharmacy Clinical Prior Authorization Assistance Chart Now Available
Texas Medicaid·Identified Feb 21, 2026
Texas HHSC has published a quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart, which shows which prior authorizations each Medicaid MCO uses and how they relate to the Vendor Drug Program. This chart helps providers understand varying prior authorization requirements across different Medicaid managed care organizations in Texas.
Low impact
Renal Dialysis and Nephrology Fee Schedules to Be Corrected
Texas Medicaid·Effective Feb 20, 2026
Texas Medicaid corrected minor fee schedule errors (one cent discrepancies) for renal dialysis and nephrology composite rates that were posted in December 2025. This is an informational notice only - no provider action is required and no claims were affected by the correction.
Low impact
Members Sought for the Texas Medical Disclosure Panel
Texas Medicaid·Identified Feb 21, 2026
The Texas Health and Human Services Commission is seeking applications for the Texas Medical Disclosure Panel, which focuses on disclosure of medical risks and hazards. This is an informational notice about volunteer panel positions, not a billing or coverage policy change.
Low impact
Reminder: Unlock LTCOP Forms
Texas Medicaid·Identified Feb 21, 2026
Texas Medicaid reminds Long-Term Care Online Portal (LTCOP) users to unlock forms when finished working to prevent access issues for other users. Users should complete updates promptly, exit forms by selecting 'Unlock Form', and avoid leaving forms open when not actively working.
High impact
Reminder: CLIA Certification Required for Laboratory Service Claims
Texas Medicaid·Identified Feb 19, 2026
Texas Medicaid now requires all laboratory service providers to have current CLIA certifications and submit claims only for services covered under their certification. Providers must update their CLIA information in PEMS and ensure compliance before billing any laboratory services.
Medium impact
TULIP Scheduled Maintenance
Texas Medicaid·Effective Feb 20, 2026
TULIP system will be unavailable for scheduled maintenance from Friday, February 20, 2026 at 9:00 PM through Saturday, February 21, 2026 at 7:00 AM. All billing team work requiring TULIP access must be completed before the maintenance window begins.
Low impact
2026-02-19 - Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate
Medicare/CMS·Effective Jan 1, 2026
The 2026 payment rate for historically excepted tribal Federally Qualified Health Centers has been set at $733 for medically necessary face-to-face visits. CMS will automatically adjust any claims previously paid at the 2025 rate, requiring no action from billing teams.
Low impact
Employment First/Employment Services In-Person Trainings
Texas Medicaid·Effective Mar 1, 2026
Texas Health and Human Services Commission is offering free Employment First/Employment Services training sessions across Texas from March to November 2026. These trainings are designed for staff supporting people with disabilities in employment goals, including service coordinators and direct care staff.
Medium impact
With Regence’s commitment to improving access and outcomes, more members than ever are getting the behavioral health care they deserve
Regence BlueCross BlueShield of Oregon·Effective Feb 12, 2026
Regence has expanded behavioral health provider networks by adding 26,000+ providers since 2021 and introduced virtual-first care options with 95% of members able to access care within 7 days. The policy highlights no-referral-needed access to specialized virtual providers (Bend Health, Charlie Health, Headway, Rula, Talkspace, etc.) and specialized treatment programs for eating disorders (Equip) and OCD (nOCD). Billing teams should verify coverage through provider websites and member accounts when processing behavioral health claims.
Low impact
CDPHP, HMRRC, and United Way of the Greater Capital Region Unite the CDPHP Workforce Team Challenge and 518 Day
CDPHP·Identified Feb 17, 2026
This is a community event announcement from CDPHP regarding the 2026 Workforce Team Challenge (a 3.5-mile road race on May 21, 2026) and 518 Day volunteer initiative. This is NOT a policy change affecting billing, coding, coverage, or claims processing for healthcare services.
Medium impact
EFT Payments Delayed Due to President’s Day Bank Holiday
Texas Medicaid·Effective Feb 16, 2026
EFT payments from TMHP will be delayed by one business day due to President's Day bank holiday on February 16, 2026. Providers should expect their electronic funds transfer payments to arrive on Monday, February 23, 2026 instead of the normal schedule.
Medium impact
Coming April 2026: First Quarter HCPCS Updates to Texas Medicaid Procedure Codes
Texas Medicaid·Effective Apr 1, 2026
Texas Medicaid will implement quarterly HCPCS procedure code updates on April 1, 2026, including code additions, revisions, and discontinuations. Discontinued codes will no longer be covered benefits, and new codes won't be reimbursed until Texas HHSC reviews them and holds rate hearings.
Low impact
Removal of Some Ibuprofen NDCs From the CHIP Formulary Effective February 12, 2026
Texas Medicaid·Effective Feb 12, 2026
Effective February 12, 2026, two specific ibuprofen NDCs (70677113602 and 70677113603) will be removed from the Texas CHIP formulary after being incorrectly added on January 13, 2026. These 200 mg ibuprofen tablets will no longer be covered under CHIP.
Medium impact
April 2026 TMPPM Update for Stereotactic Radiosurgery
Texas Medicaid·Effective Apr 1, 2026
Effective April 1, 2026, Texas Medicaid will cover stereotactic radiosurgery and proton beam radiation therapy for pediatric cancers in patients 20 years and younger, with prior authorization required. This expands coverage for these specialized cancer treatments to include children.
Medium impact
Updated Training for CSHCN Services Program Basics Now Available
Texas Medicaid·Identified Feb 14, 2026
Texas Medicaid has released updated training for the Children with Special Health Care Needs (CSHCN) Services Program, covering client eligibility, benefits, authorizations, and claim appeals. Providers must create an account on the TMHP Learning Management System to access the training.
Medium impact
Coming April 2026: First Quarter HCPCS Updates to CSHCN Services Program Procedure Codes
Texas Medicaid·Effective Apr 1, 2026
Starting April 1, 2026, TMHP will implement HCPCS code updates for the CSHCN Services Program based on CMS first quarter changes. Discontinued codes will no longer be covered benefits, while new codes won't be reimbursed until HHSC reviews them and holds rate hearings.
Medium impact
CDPHP Named to 2026 America’s Best Midsize Employers List by Forbes
CDPHP·Identified Feb 13, 2026
Failed to analyze policy change
Low impact
Reminder: Presidents’ Day Impact to LTC FFS Claim Payments
Texas Medicaid·Effective Feb 16, 2026
Presidents' Day holiday on February 16, 2026 will cause a one-day delay in Long-Term Care fee-for-service claim payments in Texas. Typical 5-business-day payment schedule will be extended by one day for claims adjudicated around the holiday.
Medium impact
2026-02-12 - Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs
Medicare/CMS·Effective Mar 1, 2026
CMS has made several updates including allowing hospital staff to access PEPPER reports, transitioning CLIA certificates to electronic-only format after March 1, 2026, and clarifying billing requirements for global surgery reporting and optometry services at nursing facilities.
Medium impact
Authorization Updates - Effective Feb, Mar, April, and May 2026
Sentara Health Plans·Identified Feb 12, 2026
Failed to analyze policy change
High impact
Medical and Clinical Policy Updates - Effective May 1, 2026
Sentara Health Plans·Effective May 1, 2026
Sentara Health Plans has updated 22 medical policies effective May 1, 2026, with changes spanning surgical procedures, imaging services, DME, and clinical treatments. Key changes include: 12 policies archived (no longer covered), 7 policies revised (coverage criteria or requirements changed), and 3 policies reviewed (clarification without coverage changes). Billing teams must immediately audit claims for archived policies and stop billing those services; for revised policies, documentation and authorization requirements may have changed.
Medium impact
Authorization Updates - Effective Feb, March, and May 2026
Sentara Health Plans·Identified Feb 12, 2026
Failed to analyze policy change

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Archive by year

2023 2024 2025 2026

MSK Authorization Will Transition from eviCore to Highmark on May 1, 2026

Prior Authorization Changes to Oncology-related Codes

Over 2800 Children Running in the Blue Cross and Blue Shield of Alabama 2026 Kids Marathon

Updated Pharmacy Clinical Prior Authorization Assistance Chart Now Available

Renal Dialysis and Nephrology Fee Schedules to Be Corrected

Members Sought for the Texas Medical Disclosure Panel

Reminder: Unlock LTCOP Forms

Reminder: CLIA Certification Required for Laboratory Service Claims

TULIP Scheduled Maintenance

2026-02-19 - Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate

Employment First/Employment Services In-Person Trainings

With Regence’s commitment to improving access and outcomes, more members than ever are getting the behavioral health care they deserve

CDPHP, HMRRC, and United Way of the Greater Capital Region Unite the CDPHP Workforce Team Challenge and 518 Day

EFT Payments Delayed Due to President’s Day Bank Holiday

Coming April 2026: First Quarter HCPCS Updates to Texas Medicaid Procedure Codes

Removal of Some Ibuprofen NDCs From the CHIP Formulary Effective February 12, 2026

April 2026 TMPPM Update for Stereotactic Radiosurgery

Updated Training for CSHCN Services Program Basics Now Available

Coming April 2026: First Quarter HCPCS Updates to CSHCN Services Program Procedure Codes

CDPHP Named to 2026 America’s Best Midsize Employers List by Forbes

Reminder: Presidents’ Day Impact to LTC FFS Claim Payments

2026-02-12 - Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs

Authorization Updates - Effective Feb, Mar, April, and May 2026

Medical and Clinical Policy Updates - Effective May 1, 2026

Authorization Updates - Effective Feb, March, and May 2026