All Insurance Policy Changes (Page 1378)

Continuing from page 1377. 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
Pharmacy and clinical updates
UnitedHealthcare·Effective Jan 1, 2026
This policy announcement indicates that UnitedHealthcare has published new pharmacy, clinical, and prior authorization updates for January 2026, but the specific content details are not accessible in the provided policy text - only the navigation structure and announcement page are visible.
Medium impact
Specialty Medical Injectable Drug program updates
UnitedHealthcare·Effective Jan 1, 2026
UnitedHealthcare has updated their Specialty Medical Injectable Drug program for January 2026, with changes to drugs requiring review at launch and updated program requirements. Healthcare providers need to access the Medical Benefit Specialty Drug Update Bulletin for complete details on the latest coverage and authorization requirements.
Low impact
Reimbursement policy updates
UnitedHealthcare·Effective Jan 1, 2026
UnitedHealthcare has published their January 2026 reimbursement policy update bulletins covering multiple plan types including Commercial, Community Plan, Individual Exchange, and Medicare Advantage. The bulletin provides access to current updates and past reimbursement policy changes but does not contain specific policy details in the provided content.
Medium impact
Medical policy updates
UnitedHealthcare·Effective Jan 1, 2026
UnitedHealthcare has released January 2026 medical policy update bulletins across all plan types including Commercial, Medicare Advantage, Medicaid, Exchange, and Dental plans. The provided content shows only the index page listing all available bulletins but does not contain the actual policy changes or specific requirements.
High impact
Medical and Clinical Policy Updates - Effective April 1, 2026
Sentara Health Plans·Effective Apr 1, 2026
Sentara Health Plans is implementing multiple medical policy updates effective April 1, 2026, including revisions to prior authorization procedures, adoption of new advanced imaging guidelines, archival of the Genetic and Molecular Testing policy (with transition to OncoHealth and Avalon vendors), and policy updates across observation care, lumbar laminectomy, TIPSS, prescription digital therapeutics, mechanical stretching devices, and radiation treatment. Additionally, effective February 1, 2026, Medical Policy 34 will be archived with authorization responsibilities transitioning to specialized vendors.
Medium impact
Authorization Updates - Effective February 1, 2026
Sentara Health Plans·Identified Jan 12, 2026
Failed to analyze policy change
Medium impact
Eating Disorder Services – No PCP Referral Required
Arkansas Medicaid·Effective Jan 7, 2026
Arkansas has eliminated the requirement for patients to obtain a Primary Care Physician (PCP) referral before accessing eating disorder services. This streamlines access to specialized eating disorder treatment by allowing direct referrals and self-referrals. Billing teams must update authorization workflows to reflect that PCP referrals are no longer a prerequisite for these services.
Medium impact
Extension of Prior Authorization (PA) for Hyperalimentation Services if the Beneficiary has a Chronic Condition
Arkansas Medicaid·Identified Jan 6, 2026
Failed to analyze policy change
High impact
Authorization Updates - Effective January 1, 2026
Sentara Health Plans·Effective Jan 1, 2026
Effective January 1, 2026, Sentara Health Plans is removing prior authorization requirements for 50+ surgical and diagnostic procedures across Medicare Advantage and Medicaid products in Virginia. This eliminates the need for precertification before performing these procedures, streamlining billing workflows and reducing administrative delays for affected specialties.
High impact
Annual Documentation Reminder
MVP Health Care·Effective Jan 1, 2026
CMS resets all Risk Adjustment scores to zero each January, requiring providers to annually recapture and thoroughly document all chronic conditions with specific clinical details to support accurate Risk Adjustment scoring. Documentation must include MEAT criteria (Monitor, Evaluate, Assess, Treat) and the highest level of diagnostic specificity at every face-to-face encounter to ensure proper care coordination and resource allocation.
Medium impact
Mvp Code of Ethics And Business Conduct Summary
MVP Health Care·Effective Jan 1, 2026
MVP has issued a refreshed Code of Ethics and Business Conduct policy (effective January 2026) that reinforces compliance requirements for all network providers, vendors, and contractors. This is primarily an informational and compliance policy requiring staff training on HIPAA, fraud prevention, anti-kickback statutes, and mandatory reporting of suspected violations through designated hotlines.
High impact
2026 January Network Connection
Presbyterian Health Plan·Effective Jan 1, 2026
Presbyterian Health Plan released its 2026 provider manuals and announced several operational changes effective January 1, 2026, including the removal of all CVS Pharmacy locations from the Medicare network, requiring patients to transfer prescriptions to in-network pharmacies. The policy also establishes mandatory well-child visit requirements within 30 days for children entering state custody (CISC) covered under Turquoise Care, with specific coding and reimbursement guidance for providers.
Low impact
Mvp Living Well Programs For Your Patients
MVP Health Care·Effective Jan 1, 2026
MVP is promoting free virtual and in-person health and wellness programs available to all patients (MVP members and non-members). This is an informational notification for providers to educate patients about available wellness resources; no billing, coding, or coverage changes are involved.
High impact
Medica Provider News: January 2026
Medica·Effective Jan 1, 2026
Medica is implementing multiple operational changes effective January 1, 2026, including: (1) migration of all electronic transactions to Availity Essentials portal for most plans, (2) new payment vendor (Optum VPay) for self-funded plans under payer ID 71890, (3) network changes for Medica with SSM Health members affecting behavioral health and chiropractic services, and (4) initiation of ACA chart review audits for 2025 dates of service with completion deadline of March 2026. Billing teams must update portal access, payment processing workflows, and prepare for medical record retrieval requests.
High impact
Special Alert January 2026 - Carelon Radiotracer Management for PET Imaging
Providence Health Plan·Effective Apr 1, 2026
Effective April 1, 2026, Carelon will require submission of both PET CPT codes and radiotracer CPT codes together during the authorization process for Brain and Oncologic PET imaging procedures. Approved authorizations will specify which radiotracer categories are allowed based on clinical indication. This change affects the intake and prior authorization workflow for PET imaging claims.
Medium impact
Mvp Using Caqh Provider Data Portal
MVP Health Care·Effective Jan 1, 2026
MVP has launched a collaboration with CAQH to allow credentialed providers to efficiently update and verify their demographic data through the CAQH Provider Data Portal. Providers must review and confirm the accuracy of their directory information at least every 90 days to maintain compliance. MVP will receive provider data from CAQH, except for registered and delegated credentialed providers who should continue updating their CAQH applications directly.
Low impact
Optum negotiations
Regence BlueCross BlueShield of Oregon·Effective Jan 1, 2026
Optum providers, facilities, and clinics remain in-network for Regence members effective January 1, 2026, with no disruption to care. This includes The Corvallis Clinic and Oregon Medical Group in Oregon, as well as Optum Care Washington (formerly The Everett Clinic and Polyclinic). Regence members continue to access in-network benefits without changes to their coverage or billing.
Medium impact
2026 Protocols For Domestic Violence Victims And Endangered Individuals
MVP Health Care·Effective Jan 1, 2026
MVP Health Plan has implemented new confidentiality protocols for domestic violence victims and endangered individuals with valid orders of protection. Members can now request that their address and contact information be kept confidential and not disclosed to the policyholder, per New York State Insurance Law § 2612. Billing and front office staff must be prepared to handle confidentiality requests and ensure alternative contact methods are used when members invoke this protection.
Medium impact
MVP Living Well Programs For Your Patients
MVP Health Care·Effective Jan 1, 2026
MVP has launched a new Prior Authorization Check – Virtual Agent, a self-service tool that allows providers to check prior authorization requirements via conversational voice interface instead of traditional touch-tone phone menus. Providers can now inquire about single or multiple prior authorization requests by calling the MVP Customer Care Center and selecting option 5, which should reduce wait times and improve efficiency in the prior authorization process.
Medium impact
Provider Policies And Payment Policies Effective January 1 2026
MVP Health Care·Identified Jan 1, 2026
Failed to analyze policy change
High impact
Medical Policy Updates
MVP Health Care·Effective Dec 1, 2025
MVP Health Care has released comprehensive medical policy updates effective December 1, 2025 and January 1, 2026, covering 13 new/revised policies (including rehabilitation, prosthetics, and digital therapeutics) and archiving 7 genetic testing policies that have been consolidated into a new Precision Genetic Testing Management framework. Billing teams must review detailed policy documents to identify coverage changes, prior authorization requirements, and coding impacts for affected services.
High impact
Formulary Policy Updates
MVP Health Care·Identified Jan 1, 2026
MVP Health Care has published Q1 2026 formulary updates affecting drug coverage for Commercial, Marketplace, and Self-Funded plans. Key changes include: 10 drugs removed from prior authorization requirements, 3 new drugs excluded from coverage, and 6 new generic medications now available. Billing and clinical teams must update prescribing and prior authorization workflows immediately.
Medium impact
Upcoming Changes to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026
Arkansas Medicaid·Identified Dec 19, 2025
Failed to analyze policy change
Medium impact
February 2026 Drug List Change Notification (Commercial)
PacificSource Health Plans·Identified Dec 19, 2025
Failed to analyze policy change
Low impact
Thank You for Your Care and Commitment
Highmark·Identified Dec 18, 2025
This is a year-end thank you message from Highmark highlighting recent improvements including expanded Gold Carding Program, new Communications Hub, monthly onboarding webinars, and Provider Chat for Pennsylvania. No billing code or coverage changes are announced.

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Archive by year

2023 2024 2025 2026

Pharmacy and clinical updates

Specialty Medical Injectable Drug program updates

Reimbursement policy updates

Medical policy updates

Medical and Clinical Policy Updates - Effective April 1, 2026

Authorization Updates - Effective February 1, 2026

Eating Disorder Services – No PCP Referral Required

Extension of Prior Authorization (PA) for Hyperalimentation Services if the Beneficiary has a Chronic Condition

Authorization Updates - Effective January 1, 2026

Annual Documentation Reminder

Mvp Code of Ethics And Business Conduct Summary

2026 January Network Connection

Mvp Living Well Programs For Your Patients

Medica Provider News: January 2026

Special Alert January 2026 - Carelon Radiotracer Management for PET Imaging

Mvp Using Caqh Provider Data Portal

Optum negotiations

2026 Protocols For Domestic Violence Victims And Endangered Individuals

MVP Living Well Programs For Your Patients

Provider Policies And Payment Policies Effective January 1 2026

Medical Policy Updates

Formulary Policy Updates

Upcoming Changes to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026

February 2026 Drug List Change Notification (Commercial)

Thank You for Your Care and Commitment