All Insurance Policy Changes (Page 1379)

Continuing from page 1378. 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
When a natural disaster strikes, Regence is here to support your care needs
Regence BlueCross BlueShield of Oregon·Effective Dec 10, 2025
Regence has implemented emergency pharmacy access policies for members affected by flooding in declared disaster areas. During officially declared emergencies, members may refill prescriptions at any pharmacy (waiving network restrictions) and receive emergency care at in-network rates. This is a temporary, disaster-response policy effective immediately for affected regions.
Medium impact
Bennett Lumber maintains a dedicated workforce with help from Regence health plans
Regence BlueCross BlueShield of Oregon·Identified Dec 8, 2025
Failed to analyze policy change
High impact
January 2026 Community Solutions (Medicaid) formulary and coverage policies notification
PacificSource Health Plans·Effective Jan 15, 2026
PacificSource Community Solutions (Medicaid) removed three medications from formulary effective January 15, 2026: Xifaxan, Actемra ACTpen, and Actемra prefilled syringe. Billing teams must identify claims for these drugs and implement denial protocols or alternative medication routing for affected Medicaid members.
High impact
Prior authorization changes for February 1, 2026 – Medicare and Medicaid
PacificSource Health Plans·Effective Feb 1, 2026
Effective February 1, 2026, PacificSource is implementing new prior authorization requirements for Medicare and Medicaid. Medicare adds 20 procedure codes requiring prior auth (including arthroscopy, unlisted procedures, and specialized diagnostics) plus 3 codes requiring prior auth only when claims exceed $500. Medicaid adds 2 codes requiring prior auth. Billing teams must update systems and verify all affected codes before service delivery to avoid claim denials.
Low impact
Our health plans’ coverage of hepatitis B vaccinations remains unchanged
Regence BlueCross BlueShield of Oregon·Effective Dec 5, 2025
This is a clarification that plan coverage for hepatitis B vaccinations remains unchanged despite new CDC ACIP recommendations (effective December 5, 2025) that limit the birth dose to infants whose mothers are hepatitis B positive or have unknown status. Plans continue to cover hepatitis B and all preventive vaccines at 100% with no member cost-sharing, regardless of administration timing.
High impact
Prior Authorization Submission Help and Tips
Highmark·Identified Dec 5, 2025
Highmark has implemented a new prior authorization submission process requiring all medical prior auth requests to be submitted through Availity Essentials via the Authorizations and Referrals workflow, not via fax or Predictal. The system has been updated to eliminate confusion and streamline the workflow with specific buttons and processes that must be followed.
Medium impact
Authorization Updates - Effective Dec 2025, Jan 2026, and Mar 2026
Sentara Health Plans·Identified Dec 4, 2025
Failed to analyze policy change
Medium impact
Coverage for Home Sleep Study (Proc Codes 95800, 95801, and 95806)
Arkansas Medicaid·Effective Dec 3, 2025
Arkansas has issued a provider notice regarding coverage for Home Sleep Study procedures (CPT 95800, 95801, 95806). The policy was posted on December 3, 2025, and appears to establish or clarify coverage parameters for these sleep study codes. However, the actual policy content is not available in this summary—only the title and source URL are provided.
Low impact
Continued access to care through St. Charles & Salem Health for Commercial and Medicare Members
PacificSource Health Plans·Effective Jan 1, 2026
PacificSource has secured continued in-network agreements with St. Charles Health System and Salem Health Hospitals & Clinics for Commercial and Medicare plans in 2026 (and 2027 for St. Charles Commercial). No coverage or provider access changes for Commercial and Medicare members—billing teams should take no action as claims processing workflow remains unchanged. Note: Medicaid coverage with Salem Health is still under negotiation.
High impact
Medica Provider News: December 2025
Medica·Effective Jan 1, 2026
Medica is implementing multiple operational changes effective January 1, 2026, including payer ID transitions for four commercial products (moving to payer ID 71890), payment vendor changes to Optum/VPay for self-funded plans, network changes for IFB/Marketplace members (new behavioral health and chiropractic networks with different payer IDs), and a biosimilar coverage change for adalimumab products effective November 1, 2025. Additionally, administrative terminations will occur for providers who do not respond to recredentialing requests within 36 months.
Medium impact
Identification of Microorganisms Using Nucleic Acid Probes (2.04.10)
Blue Shield of California·Effective Apr 1, 2026
Blue Shield of California updated their nucleic acid probe testing policy effective April 1, 2026, defining which microorganisms are covered for direct/amplified probe testing versus investigational. The policy covers 32 specific microorganisms including COVID-19, flu, STDs, and respiratory pathogens, while limiting outpatient respiratory viral panels to 5 targets or less.
Medium impact
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders (2.04.102)
Blue Shield of California·Effective Apr 1, 2026
Blue Shield of California updated their policy for whole exome and whole genome sequencing, establishing specific medical necessity criteria for genetic testing in unexplained congenital/neurodevelopmental disorders and critically ill infants. The policy clarifies when these tests are considered medically necessary versus investigational, with different requirements for standard versus rapid sequencing.
High impact
Special Alert December 2025 - Taxonomy Requirements
Providence Health Plan·Effective Mar 15, 2026
Effective March 15, 2026, Providence Health Plan (PHP) and Providence Health Assurance (PHA) will require taxonomy codes on all provider-submitted Medicare and Commercial claims. Claims submitted with missing or incorrect taxonomy codes will be denied. Providers must ensure their taxonomy codes are registered with CMS and included in all claim submissions.
Low impact
Rib Remodeling and Clavicle Shortening (BSC7.21)
Blue Shield of California·Effective Mar 1, 2026
Blue Shield of California has issued a new policy classifying all rib remodeling procedures (including WASP, RIBOSS, RibXcar, and UUAIST) and clavicle shortening for body contouring as investigational and non-covered services. This policy becomes effective March 1, 2026.
High impact
Special Alert December 2025 - Medicaid Benefit: Complex Rehab Technology (CRT) Repair at Providence Health Plan
Providence Health Plan·Effective Jan 1, 2026
Effective January 1, 2026, Providence Health Plan (Oregon Medicaid) eliminates prior authorization requirements for Complex Rehab Technology (CRT) repairs under Senate Bill 549. Providers must bill all CRT repair claims using modifier RB to ensure proper processing and avoid denials. Prior authorization is still required only for CRT replacements, new equipment/upgrades, or items that don't meet the SB 549 CRT definition.
Medium impact
Provider Chat Update: 24/7 Auth Status Check Is Now Live
Highmark·Effective Nov 24, 2024
Highmark has launched a new 24/7 automated authorization status check feature through Provider Chat in Availity. Providers can now check authorization status instantly at any time by accessing Provider Chat and selecting the 'Auth Status' option or typing relevant phrases.
Low impact
Continued access to care through St. Charles Health System
PacificSource Health Plans·Effective Jan 1, 2026
PacificSource has secured network agreements with St. Charles Health System for Commercial plans (2026-2027) and Medicare plans (2026). No billing workflow changes are required—St. Charles providers remain in-network, and member coverage and access continue unchanged.
Medium impact
REVISED: 2025 Quarter 4 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion
Arkansas Medicaid·Identified Nov 14, 2025
Failed to analyze policy change
Medium impact
Fall 2025 Authorization Updates
Sentara Health Plans·Identified Nov 14, 2025
Failed to analyze policy change
High impact
Medicaid and Commercial Prior Authorization Changes
PacificSource Health Plans·Effective Jan 1, 2026
Effective January 1, 2026, both Commercial and Medicaid plans are implementing new prior authorization requirements for specific CPT/HCPCS codes. Additionally, certain HCPCS codes for Medicaid require prior authorization only when item costs exceed $500. The billing team must identify affected codes and implement authorization workflows before services are rendered.
Medium impact
Authorization Updates - Effective February 1, 2026
Sentara Health Plans·Identified Nov 6, 2025
Failed to analyze policy change
High impact
Medical Association and Blue Cross and Blue Shield of Alabama Announce Patient Centered Enhancements to Prior Authorization Process
Blue Cross Blue Shield of Alabama·Identified Nov 4, 2025
Blue Cross and Blue Shield of Alabama has implemented patient-centered enhancements to its prior authorization process, including elimination of AI-based denials, reduced repeat authorizations for chronic conditions, no reversal of approved services, expanded Gold Carding for trusted providers, online real-time approvals, 90-day prior auth portability between plans, and clearer transparency rules with 45-day notice for changes.
Medium impact
New Coverage for B4100 U1 – SIMPLY THICK FOOD THICKENER ORAL - CONCENTRATE/1 OZ
Arkansas Medicaid·Effective Nov 3, 2025
Arkansas Medicaid has added new coverage for B4100 U1 (SIMPLY THICK FOOD THICKENER ORAL - CONCENTRATE/1 OZ), a food thickening product. Billing teams must recognize this HCPCS code as a covered procedure code effective immediately and ensure claims are processed under the correct category.
Medium impact
Change to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026
Arkansas Medicaid·Identified Nov 3, 2025
Failed to analyze policy change
Medium impact
Behavioral Health Treatment for Autism Spectrum Disorder or Pervasive Developmental Disorder (BSC3.01)
Blue Shield of California·Effective Dec 1, 2025
Blue Shield of California updated their behavioral health treatment policy for autism spectrum disorder and pervasive developmental disorder, establishing specific criteria for initial assessments, treatment initiation, and continued care with detailed requirements for prior authorization and documentation.

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Archive by year

2023 2024 2025 2026

When a natural disaster strikes, Regence is here to support your care needs

Bennett Lumber maintains a dedicated workforce with help from Regence health plans

January 2026 Community Solutions (Medicaid) formulary and coverage policies notification

Prior authorization changes for February 1, 2026 – Medicare and Medicaid

Our health plans’ coverage of hepatitis B vaccinations remains unchanged

Prior Authorization Submission Help and Tips

Authorization Updates - Effective Dec 2025, Jan 2026, and Mar 2026

Coverage for Home Sleep Study (Proc Codes 95800, 95801, and 95806)

Continued access to care through St. Charles & Salem Health for Commercial and Medicare Members

Medica Provider News: December 2025

Identification of Microorganisms Using Nucleic Acid Probes (2.04.10)

Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders (2.04.102)

Special Alert December 2025 - Taxonomy Requirements

Rib Remodeling and Clavicle Shortening (BSC7.21)

Special Alert December 2025 - Medicaid Benefit: Complex Rehab Technology (CRT) Repair at Providence Health Plan

Provider Chat Update: 24/7 Auth Status Check Is Now Live

Continued access to care through St. Charles Health System

REVISED: 2025 Quarter 4 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion

Fall 2025 Authorization Updates

Medicaid and Commercial Prior Authorization Changes

Authorization Updates - Effective February 1, 2026

Medical Association and Blue Cross and Blue Shield of Alabama Announce Patient Centered Enhancements to Prior Authorization Process

New Coverage for B4100 U1 – SIMPLY THICK FOOD THICKENER ORAL - CONCENTRATE/1 OZ

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

Behavioral Health Treatment for Autism Spectrum Disorder or Pervasive Developmental Disorder (BSC3.01)