All Insurance Policy Changes (Page 1383)

Continuing from page 1382. 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
Updates to Wheelchair Accessories Procedure Codes E1028 and E1032-E1034
Arkansas Medicaid·Identified Jul 21, 2025
Failed to analyze policy change
Low impact
Three tips to protect yourself from wildfire smoke
Regence BlueCross BlueShield of Oregon·Identified Jul 18, 2025
This is a patient health advisory from Regence about wildfire smoke protection and respiratory health management. It is NOT a policy change affecting billing, coding, claims processing, or insurance coverage. It provides educational guidance to members about air quality monitoring, exposure reduction, and managing respiratory conditions during wildfire events.
High impact
Coverage for Procedure Codes 58300 and 58301
Arkansas Medicaid·Identified Jul 17, 2025
Arkansas has issued a provider notice regarding coverage for procedure codes 58300 and 58301. However, the policy document content is not provided in this summary—only metadata is available. The billing team cannot determine specific coverage changes, requirements, or effective dates without access to the full policy document.
Medium impact
Inpatient Claims and Use of Condition Codes
Arkansas Medicaid·Identified Jul 15, 2025
Failed to analyze policy change
Low impact
Stronger security for InTouch and the myPacificSource app
PacificSource Health Plans·Effective Aug 15, 2025
PacificSource is implementing enhanced security measures for InTouch member portal and myPacificSource app, effective mid-August 2025. Members will be required to update credentials one-time and subsequently authenticate via multi-factor authentication (text/call with numeric codes) at each login. This is an operational/administrative change affecting member portal access, not billing codes or clinical procedures.
High impact
REVISED New Coverage - Presumptive Eligibility – Pregnant Women (PE-PW)
Arkansas Medicaid·Identified Jul 2, 2025
Unable to provide complete analysis. The policy document (ON-020-25.docx) was not accessible for review—only the summary metadata was available. This appears to be a revised billing instruction for Presumptive Eligibility coverage for pregnant women under Arkansas Medicaid, posted July 2, 2025. Full policy details, effective dates, specific billing codes, and implementation requirements cannot be confirmed without access to the complete document.
Medium impact
Transcatheter Tricuspid Valve Repair or Replacement (2.02.34)
Blue Shield of California·Effective Jul 1, 2025
Blue Shield of California established new medical policy 2.02.34 effective July 1, 2025, covering transcatheter tricuspid valve repair (T-TEER) and replacement (TTVR) procedures for patients with severe tricuspid regurgitation who are intermediate/high surgical risk candidates. The policy defines specific FDA-approved devices (TriClip for repair, EVOQUE for replacement) as medically necessary under strict criteria including heart team evaluation and maximally tolerated medical therapy.
Medium impact
New Formula Procedure Codes and Formula Rate Changes - Effective 7/15/2025
Arkansas Medicaid·Identified Jul 1, 2025
Failed to analyze policy change
Medium impact
Tibial Nerve Stimulation (7.01.106)
Blue Shield of California·Effective Jul 1, 2025
Blue Shield of California updated their tibial nerve stimulation policy effective July 1, 2025. Percutaneous tibial nerve stimulation (PTNS) is now covered for non-neurogenic overactive bladder patients who have failed both behavioral therapy (8-12 weeks) and pharmacologic therapy (4-8 weeks), with maintenance therapy covered monthly after successful initial treatment.
High impact
Medica Provider News: July 2025
Medica·Effective Oct 1, 2025
Medica is implementing multiple policy changes effective October 1, 2025: retiring the Medical Injectables List (providers must use Prime Therapeutics website instead), and revising IONM reimbursement requirements to mandate Study Code and Place of Service codes 19/21/22/24 with prohibition on billing by surgeons/anesthesiologists. Additionally, credentialing procedures are being enhanced effective immediately with new locum tenens requirements, health equity language mandates, monthly license expiration reviews, and changes to recredentialing notification letters starting October 1.
Low impact
Introducing Empower Magazine From Mvp
MVP Health Care·Effective Jul 1, 2025
MVP Health Care is introducing Empower, a new full-color wellness magazine for members available in English and Spanish. Providers can request complimentary copies for lobby distribution or patient handouts by contacting their MVP Provider Relations Representative. This is a member communication and engagement initiative with no billing, coding, or clinical workflow impact.
High impact
Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide July 1, 2025
Presbyterian Health Plan·Effective Jul 1, 2025
Presbyterian Health Plan is updating its Medical Policy Manual and Prior Authorization Guide effective July 1, 2025. The update includes new coverage policies for gender-affirming treatment/surgery, genetic testing (multiple types), gastric electric stimulation, peripheral nerve stimulation, and home health care; removes coverage for 10 previously covered services (including bone marrow transplants, organ transplants, sacral nerve stimulation, and others); and modifies requirements for durable medical equipment and rehabilitation devices. Billing teams must verify prior authorization requirements for all affected procedures using Presbyterian's updated tools.
Medium impact
Updated Health Access Standard Requirements
MVP Health Care·Effective Jul 1, 2025
MVP has updated its Health Access Standard Requirements to clarify scheduling timelines and availability requirements by specialty and plan type. The policy defines emergency conditions (requiring immediate access), urgent medical conditions (24-hour access), and urgent behavioral health conditions. Practices must ensure their contact information is current in MVP's Find a Doctor Directory to enable accurate member access.
Medium impact
Mvps Participation With Caqh Provider Data Portal
MVP Health Care·Effective Jul 1, 2025
MVP Insurance has begun participating with CAQH (Council for Affordable Quality Healthcare) as of July 1, 2025. Credentialed providers must now respond to CAQH notifications from MVP to review and verify their demographic and professional information in the CAQH Provider Data Portal. Behavioral health providers should include detailed credentials, specialties, and patient populations to ensure accurate member matching.
Low impact
Mvp Living Well Programs For Your Patients
MVP Health Care·Effective Jul 1, 2025
MVP Healthcare is promoting complimentary virtual and in-person health and wellness programs available to all patients (MVP members and non-members) starting in Q3 2025. This is an informational bulletin encouraging providers to educate patients about free wellness offerings; it does not create new billing requirements or change coverage policies.
Medium impact
2025 July Network Connection
Presbyterian Health Plan·Effective Aug 1, 2025
Presbyterian is transitioning its mail-order prescription service from Optum Home Delivery to Costco Pharmacy effective August 1, 2025, for non-specialty medications only. Members must enroll with Costco Pharmacy to continue receiving mail-order prescriptions, and no Costco membership is required. Providers can begin sending prescriptions to Costco Pharmacy Mail Order immediately via electronic or fax submission.
Low impact
Helping to Improve Patient Outcomes
MVP Health Care·Identified Jul 1, 2025
MVP is encouraging providers to help patients complete Authorization to Disclose Information (ADI) Forms to improve care coordination and communication between providers. This is a care coordination initiative supported by MVP Case Managers, not a billing or coverage policy change. There are no specific billing workflow requirements, coding changes, or claim submission alterations.
Low impact
Encourage Your Patients to Take Action
MVP Health Care·Effective Jul 1, 2025
MVP Healthcare is requesting that providers encourage Medicare patients to complete the Medicare Health Outcomes Survey (HOS) running July–November 1, 2025. This is an informational directive to support patient participation in a CMS quality measurement survey covering wellness topics like fall risk, mental health, and physical activity. No billing codes, coverage changes, or reimbursement impacts are involved.
Medium impact
Balloon Spacers for Treatment of Irreparable Rotator Cuffs of the Shoulder (7.01.180)
Blue Shield of California·Effective Jul 1, 2025
Blue Shield of California has classified subacromial balloon spacer implantation for massive, irreparable rotator cuff tears as investigational and not covered. This affects orthopedic procedures using balloon spacers like the InSpace system for shoulder rotator cuff treatment.
Medium impact
Prescribing Information for Durable Medical Equipment and Updates to Orthotic Procedure Codes L3204, L3206, and L3207
Arkansas Medicaid·Identified Jun 30, 2025
Failed to analyze policy change
Medium impact
REVISED - Obstetrics (OB) Services Billing Changes (Global/Itemized) and Postpartum Visits
Arkansas Medicaid·Identified Jun 26, 2025
Failed to analyze policy change
Medium impact
Medicaid Grievance and Appeals policies
PacificSource Health Plans·Effective Jun 25, 2025
PacificSource has updated its Medicaid Grievance and Appeals policies effective June 25, 2025. The policy provides guidance on grievance procedures, appeals processes, member education requirements, and notices of adverse benefit determinations. Billing teams must ensure claims processes align with these new member communication and appeal notification requirements.
Low impact
Blue Cross and Blue Shield of Alabama Proud to Sponsor The 2025 World Police & Fire Games
Blue Cross Blue Shield of Alabama·Identified Jun 23, 2025
This is a sponsorship announcement from Blue Cross and Blue Shield of Alabama regarding the 2025 World Police & Fire Games event. This is not a policy change affecting billing, coverage, reimbursement, or claim processing for healthcare services.
Medium impact
Blue Cross and Blue Shield of Alabama Recognized as One of America’s Best Customer Service Providers by USA Today
Blue Cross Blue Shield of Alabama·Identified Jun 11, 2025
Failed to analyze policy change
Medium impact
Regence BlueCross BlueShield of Oregon and its corporate foundation partner with James Beard Public Market to improve health through nutrition education and food access
Regence BlueCross BlueShield of Oregon·Identified Jun 10, 2025
Failed to analyze policy change

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Archive by year

2023 2024 2025 2026

Updates to Wheelchair Accessories Procedure Codes E1028 and E1032-E1034

Three tips to protect yourself from wildfire smoke

Coverage for Procedure Codes 58300 and 58301

Inpatient Claims and Use of Condition Codes

Stronger security for InTouch and the myPacificSource app

REVISED New Coverage - Presumptive Eligibility – Pregnant Women (PE-PW)

Transcatheter Tricuspid Valve Repair or Replacement (2.02.34)

New Formula Procedure Codes and Formula Rate Changes - Effective 7/15/2025

Tibial Nerve Stimulation (7.01.106)

Medica Provider News: July 2025

Introducing Empower Magazine From Mvp

Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide July 1, 2025

Updated Health Access Standard Requirements

Mvps Participation With Caqh Provider Data Portal

Mvp Living Well Programs For Your Patients

2025 July Network Connection

Helping to Improve Patient Outcomes

Encourage Your Patients to Take Action

Balloon Spacers for Treatment of Irreparable Rotator Cuffs of the Shoulder (7.01.180)

Prescribing Information for Durable Medical Equipment and Updates to Orthotic Procedure Codes L3204, L3206, and L3207

REVISED - Obstetrics (OB) Services Billing Changes (Global/Itemized) and Postpartum Visits

Medicaid Grievance and Appeals policies

Blue Cross and Blue Shield of Alabama Proud to Sponsor The 2025 World Police & Fire Games

Blue Cross and Blue Shield of Alabama Recognized as One of America’s Best Customer Service Providers by USA Today

Regence BlueCross BlueShield of Oregon and its corporate foundation partner with James Beard Public Market to improve health through nutrition education and food access