All Insurance Policy Changes (Page 140)

Continuing from page 139. 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
Attention Provider Type 17 (Special Clinics) Specialty 188 (Certified Community Behavioral Health Clinic): Annual Medicare Economic Index (MEI) Rate Adjustment Implemented
Nevada Medicaid·Effective Jul 1, 2026
Nevada Medicaid has implemented an annual Medicare Economic Index (MEI) rate adjustment for Certified Community Behavioral Health Clinics (CCBHCs) effective July 1, 2026. This is a go-forward rate change affecting procedure code T1040; no retroactive reprocessing will occur.
Medium impact
Quarter 3 2026 New Code Update
Nevada Medicaid·Effective Jul 1, 2026
Nevada Medicaid has activated rates for new Quarter 3 2026 CPT, HCPCS, and ADA codes in their MMIS system. Effective July 1, 2026, claims using new codes will process without automatic suspension for missing rates. This update fulfills the previous announcement (Web Announcement 3945) by adding the actual reimbursement rates to the system.
High impact
New Electronic Remit Regeneration Requests on the eMedNY Website
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing significantly shortened prior authorization timelines effective January 1, 2027, reducing standard PA decisions from 21 days to 7 days and expedited requests to 72 hours. Additionally, NYS Medicaid now covers comprehensive breast cancer screening services (mammography, ultrasound, MRI, and genetic testing) with no patient cost-sharing per state law.
High impact
New York State Medicaid Prescriber Education Program: Free 1.5 Hour Continuing Education on Antibiotic Stewardship
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid has updated prior authorization (PA) timelines effective January 1, 2027, reducing standard PA processing from 21 days to 7 days, with expedited requests now requiring 72-hour determination. The policy also expands breast cancer screening coverage (including mammography, tomosynthesis, ultrasound, and MRI) with no patient cost-sharing and provides specific billing codes and clinical guidelines for covered services.
High impact
New York State Medicaid Evidence Based Benefit Review Advisory Committee to Review AI-Enabled Devices for Diabetic Retinopathy Screening
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing federal prior authorization timeline requirements effective January 1, 2027, reducing standard PA processing from 21 days to 7 days and expedited requests to 72 hours. Additionally, NYS Medicaid is expanding breast cancer screening coverage to include mammography, tomosynthesis, ultrasound, MRI, and genetic testing with no cost-sharing for eligible populations, including transgender and gender-diverse individuals per updated clinical guidelines.
High impact
Billing for Services Provided to the Office of Mental Health Residential Treatment Facility Residents
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing CMS-mandated prior authorization timeline changes effective January 1, 2027, reducing standard PA processing from 21 days to 7 days (with up to 14-day extension for additional information) and establishing 72-hour expedited PA timelines. Additionally, NYS Medicaid now covers breast cancer screening, diagnostic imaging, and testing services with no patient cost-sharing, including mammography, ultrasound, MRI, and biopsies when medically necessary per clinical guidelines.
High impact
Reminder: Medicaid Attestation Required for New York State Medicaid Members Enrolled in Qualifying Clinical Trials
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing CMS-mandated prior authorization timeline changes effective January 1, 2027, reducing standard PA decisions from 21 days to 7 days (extendable to 14 days), and expedited requests to 72 hours. Additionally, NYS Medicaid now covers breast cancer screening, diagnostic imaging, and genetic testing with no cost-sharing, including mammography, tomosynthesis, ultrasound, and MRI based on clinical guidelines.
High impact
New York State Medicaid Coverage of Basivertebral Nerve Ablation
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing federal CMS prior authorization timeline requirements effective January 1, 2027. Standard prior auth requests must be processed within 7 days (extendable to 14 days for additional information), and expedited requests within 72 hours. This supersedes the previous 21-day timeframe and requires providers to submit complete documentation to avoid automatic denials. The policy also includes updated coverage guidelines for breast cancer screening services with specific CPT codes for mammography and tomosynthesis.
High impact
Increase in Reimbursement for Article 28 Clinic Providers Delivering Mental Health Services
NY Medicaid·Effective Jan 1, 2027
This policy contains multiple updates effective January 1, 2027: (1) NYS Medicaid prior authorization timelines are changing from 21 days to 7 days for standard requests and 72 hours for expedited requests, with a potential 14-day extension for additional information; (2) NYS Medicaid now covers breast cancer screening, diagnostic imaging, and testing with no patient cost-sharing, including mammograms, ultrasounds, MRI, and biopsies per specific clinical guidelines. The policy also encourages provider enrollment in ePACES/eMedNY eXchange for electronic claim submission and real-time prior auth requests.
High impact
New York State Medicaid Reminder on Documentation and Records Retention Requirements
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing federal CMS prior authorization timeline requirements effective January 1, 2027: standard PA requests must be adjudicated within 7 days (extendable to 14 days with additional documentation needed), and expedited PA requests within 72 hours. Additionally, NYS Medicaid now covers breast cancer screening, diagnostic imaging, and related services with no patient cost-sharing, including mammography (all ages with appropriate clinical criteria), tomosynthesis, ultrasound, MRI, and genetic testing.
High impact
Childhood Vaccine Counseling
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid implements CMS-mandated prior authorization timeline changes effective January 1, 2027, reducing standard PA processing from 21 days to 7 days (with up to 14-day extension for additional information) and establishing 72-hour expedited PA timelines. Additionally, NYS Medicaid expands coverage for breast cancer screening and diagnostic services with no patient cost-sharing, including mammography, tomosynthesis, ultrasound, MRI, and genetic testing per clinical guidelines.
High impact
New York State Medicaid Coverage of Breast Cancer Screening, Imaging, and Testing for Management and Treatment
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing federal CMS prior authorization timeline changes effective January 1, 2027, reducing standard PA processing from 21 days to 7 days (with up to 14-day extension if additional info needed) and establishing 72-hour expedited PA timelines. Additionally, NYS Medicaid now provides comprehensive coverage for breast cancer screening, diagnostic imaging (mammography, ultrasound, MRI), and genetic testing with no patient cost-sharing, including services for transgender and gender-diverse individuals per updated clinical guidelines.
High impact
New PA Timelines:
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing federally mandated prior authorization (PA) timeline changes effective January 1, 2027, reducing standard PA processing from 21 days to 7 days, with expedited requests determined within 72 hours. The policy also clarifies NYS Medicaid coverage for breast cancer screening and diagnostic services (mammography, ultrasound, MRI, biopsy) with no cost-sharing to patients, including specific guidelines for transgender and gender-diverse individuals.
High impact
Prior Approval Changes Effective January 1, 2027
NY Medicaid·Effective Jan 1, 2027
New York State Medicaid is implementing federally-mandated prior authorization timeline changes effective January 1, 2027. Standard prior auth requests must now be processed within 7 days (previously 21 days), expedited requests within 72 hours, with up to 14-day extensions permitted. The policy also clarifies NYS Medicaid coverage for breast cancer screening, imaging, and testing services including mammography, tomosynthesis, ultrasound, MRI, and genetic testing at no cost to patients.
High impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Texas·Effective Aug 1, 2026
Blue Cross and Blue Shield of Texas is implementing prior authorization requirement changes for commercial and government program members, effective in two phases: October 1, 2026 for commercial members (adding radiology, sleep, molecular genetic lab, medical oncology, and drug codes to utilization management review) and August 1, 2026 for Medicare Advantage members (implementing Part B Step Therapy Program and adjusting code reviews). Billing teams must verify which utilization management vendor (Carelon, EviCore, or BCBSTX) handles each service type and obtain prior authorization accordingly.
Medium impact
Register now for our new Provider Portal all-user account registration training beginning July 27
Priority Health·Effective Sep 1, 2024
Priority Health is launching a new Provider Portal on September 1, 2024, replacing the Prism system. All providers requiring portal access must complete account registration by August 3 and attend mandatory training. This is an operational/system migration that affects how providers access and manage accounts, not a billing or clinical policy change.
High impact
Updated Categories for Medicare Advantage Part B Step Therapy
Florida Blue·Effective Jul 15, 2026
Florida Blue Medicare updated its Part B Step Therapy program effective July 15, 2026, reclassifying certain cancer supportive therapy and immune globulin products from preferred to non-preferred (requiring step therapy), while moving a limited number of products to preferred status. Billing teams must update prior authorization requirements and preferred drug lists in their systems to reflect these changes.
High impact
CMS RADV Audit For Medicare Advantage Members
Florida Blue·Effective Jun 1, 2026
CMS is conducting a Risk Adjustment Data Validation (RADV) audit for Florida Blue Medicare Advantage members with 2020 dates of service. Providers may receive medical records requests between June-November 2026 and must submit requested records within 10 business days (maximum 45 days from request date) to support CMS's validation of diagnosis coding accuracy for Medicare Advantage risk adjustment payments.
Low impact
Free Smoking Cessation Program Available to Members, July 2026x
Florida Blue·Effective Jul 1, 2026
Florida Blue is promoting a free smoking cessation program available to all Florida Blue members ages 18+ through a partnership with the Florida Department of Health and AHEC. The program offers flexible in-person, virtual, or phone sessions, free nicotine replacement therapy (patches, gum, lozenges), and bilingual support. This is an informational bulletin encouraging providers to refer eligible patients; it does not create new billing requirements or change coverage policies.
Medium impact
5160:1-2-12 - Medicaid: non-citizens. (Amend/Original File)
Ohio Medicaid·Effective Jun 29, 2026
This is an Ohio Department of Medicaid rule amendment (5160:1-2-12) governing eligibility for non-citizens under Medicaid. The policy has been filed as an Original File Amendment effective June 29, 2026, but the specific content changes are not detailed in the provided source material. Billing teams should review the full rule body when published to determine if eligibility verification or documentation requirements for non-citizen beneficiaries have changed.
Medium impact
5160:1-3-05.11 - Medicaid: automobiles and other modes of transportation as resources. (Amend/Original File)
Ohio Medicaid·Identified Jun 30, 2026
Failed to analyze policy change
Medium impact
5160:1-3-05.19 - Medicaid: real or personal property essential to self-support. (Amend/Original File)
Ohio Medicaid·Identified Jun 30, 2026
Failed to analyze policy change
High impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Montana·Effective Aug 1, 2026
Blue Cross and Blue Shield of Montana is updating prior authorization requirements for commercial, Medicare Advantage, and Medicaid members, effective on staggered dates between August and October 2026. Changes include additions and removals of radiology, molecular genetic testing, medical oncology, and miscellaneous codes under different utilization management vendors (Carelon, BCBSMT, EviCore), and implementation of a Part B Step Therapy Program for Medicare Advantage members.
Low impact
Publicly Owned Transportation Providers – Ground Emergency Medical Transportation (GEMT) Supplemental Payments
Illinois Medicaid - HFS·Identified Jun 30, 2026
This is a payment notice for Illinois publicly owned transportation providers enrolled in the Ground Emergency Medical Transportation (GEMT) program. Providers must submit FY2026 Quarter 3 payments (covering 1/1/2026–3/31/2026) by July 31, 2026, using either ACH Direct Debit (preferred) or check payment methods.
High impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS New Mexico·Effective Aug 1, 2026
Blue Cross Blue Shield of New Mexico is implementing significant prior authorization requirement changes across multiple service categories (radiology advanced imaging, sleep services, molecular genetic testing, medical oncology, and miscellaneous drug codes) effective October 1, 2026 for commercial and Medicaid Turquoise Care members, and August 1, 2026 for Medicare Advantage members. These changes involve shifting utilization management review responsibilities between BCBSNM, Carelon, and Evicore, and require billing teams to verify current prior authorization requirements before rendering services.

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Archive by year

2023 2024 2025 2026

Attention Provider Type 17 (Special Clinics) Specialty 188 (Certified Community Behavioral Health Clinic): Annual Medicare Economic Index (MEI) Rate Adjustment Implemented

Quarter 3 2026 New Code Update

New Electronic Remit Regeneration Requests on the eMedNY Website

New York State Medicaid Prescriber Education Program: Free 1.5 Hour Continuing Education on Antibiotic Stewardship

New York State Medicaid Evidence Based Benefit Review Advisory Committee to Review AI-Enabled Devices for Diabetic Retinopathy Screening

Billing for Services Provided to the Office of Mental Health Residential Treatment Facility Residents

Reminder: Medicaid Attestation Required for New York State Medicaid Members Enrolled in Qualifying Clinical Trials

New York State Medicaid Coverage of Basivertebral Nerve Ablation

Increase in Reimbursement for Article 28 Clinic Providers Delivering Mental Health Services

New York State Medicaid Reminder on Documentation and Records Retention Requirements

Childhood Vaccine Counseling

New York State Medicaid Coverage of Breast Cancer Screening, Imaging, and Testing for Management and Treatment

New PA Timelines:

Prior Approval Changes Effective January 1, 2027

Prior Authorization Changes for Some Commercial and Government Program Members

Register now for our new Provider Portal all-user account registration training beginning July 27

Updated Categories for Medicare Advantage Part B Step Therapy

CMS RADV Audit For Medicare Advantage Members

Free Smoking Cessation Program Available to Members, July 2026x

5160:1-2-12 - Medicaid: non-citizens. (Amend/Original File)

5160:1-3-05.11 - Medicaid: automobiles and other modes of transportation as resources. (Amend/Original File)

5160:1-3-05.19 - Medicaid: real or personal property essential to self-support. (Amend/Original File)

Prior Authorization Changes for Some Commercial and Government Program Members

Publicly Owned Transportation Providers – Ground Emergency Medical Transportation (GEMT) Supplemental Payments

Prior Authorization Changes for Some Commercial and Government Program Members