All Insurance Policy Changes (Page 144)

Continuing from page 143. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
July 16, 2024 Kaiser Permanente hospitals rated among nation’s best U.S. News & World Report recognizes Kaiser Permanente’s medical facilities …
Kaiser Permanente·Identified Jun 27, 2026
This is a press release announcing that Kaiser Permanente hospitals received recognition from U.S. News & World Report for being rated among the nation's best hospitals. This is a public relations/marketing announcement with no billing, coding, coverage, or operational policy changes for medical billing teams.
Low impact
August 14, 2024 Kaiser Permanente improves member experience with AI-enabled clinical technology Assisted clinical documentation tool from Abridge helps doctors reduce …
Kaiser Permanente·Identified Jun 27, 2026
Kaiser Permanente has implemented an AI-enabled clinical documentation tool from Abridge to assist physicians with automated documentation during clinical encounters. This is an informational update about a care delivery technology enhancement that may affect clinical workflows and documentation practices for providers in Kaiser Permanente regions, but does not establish new billing requirements or policy changes at this time.
Low impact
October 23, 2024 Kaiser Permanente partners with Atlanta Hawks to promote health and wellness Organization becomes the NBA team’s official health plan provider.
Kaiser Permanente·Identified Jun 27, 2026
Kaiser Permanente has entered into a sponsorship partnership with the Atlanta Hawks NBA team to serve as their official health plan provider. This is a marketing and organizational partnership announcement with no direct impact on billing codes, coverage policies, or claim processing procedures.
Low impact
December 11, 2024 Kaiser Permanente Portland hospitals named Best Hospitals for Maternity Care Sunnyside and Westside medical centers have been named to U.S. News & World …
Kaiser Permanente·Identified Jun 27, 2026
This is a press release announcing that Kaiser Permanente Portland's Sunnyside and Westside medical centers received U.S. News & World Report recognition for maternity care quality. This is an organizational accolade with no direct impact on billing codes, coverage policies, or reimbursement requirements.
Low impact
July 29, 2025 Kaiser Permanente hospitals named among best in nation U.S. News & World Report recognizes Kaiser Permanente’s medical facilities …
Kaiser Permanente·Identified Jun 27, 2026
This is a press release announcing that Kaiser Permanente hospitals received recognition from U.S. News & World Report for quality rankings. This is a marketing/news announcement with no billing policy changes, code updates, or coverage modifications affecting medical billing operations.
Medium impact
August 15, 2025 Nationally recognized for high-quality cardiovascular care The American Heart Association presents Get With The Guidelines® awards …
Kaiser Permanente·Identified Jun 27, 2026
Failed to analyze policy change
Medium impact
MTM Health To Provide Medical Transportation for Medicaid Members
BCBS Texas·Effective Oct 1, 2026
Effective October 1, 2026, MTM Health will replace Modivcare as the sole nonemergency medical transportation provider for Medicaid members. Eligible patients must contact MTM Health to request services, though recurring trips and pre-scheduled trips after Oct 1 will automatically transfer. The billing team should monitor for any associated billing or prior authorization requirement changes.
Low impact
[Indiana] Save the Date: July 2026 Live Provider Orientation
CareSource·Identified Jun 27, 2026
CareSource Indiana is hosting a live provider orientation on July 16, 2026, tailored for newly contracted medical providers and healthcare facilities. This is an informational announcement with a registration link; no billing, coding, or coverage changes are involved.
Low impact
Do you know about our BlueCard processes?
BCBS Michigan·Identified Jun 26, 2026
This is an informational policy update from Blue Cross Blue Shield of Michigan clarifying existing BlueCard processes for out-of-state member claims. It reiterates coverage verification procedures, prior authorization requirements, and timely filing deadlines (12 months for facility claims, 180 days for professional claims, 24 months for claim adjustments). No substantive policy changes are announced—this appears to be a refresher on established BlueCard procedures.
Medium impact
New FAQ on electronic medical record connectivity is now available
BCBS Michigan·Identified Jun 26, 2026
Blue Cross Blue Shield of Michigan and Blue Care Network have implemented automatic electronic medical record (EMR) connectivity for select EMR vendors (Allscripts/Veradigm, Practice Fusion, NextGen, athenaPayer, eClinicalWorks, TouchWorks). This enables direct data exchange between provider EMRs and the payers without manual submission. A new FAQ document is available on the provider portal explaining how the data exchange works, affected providers/members, and benefits.
Low impact
Dr. Beecroft: Using measurement-based care in depression, anxiety and suicide risk to improve outcomes
BCBS Michigan·Identified Jun 26, 2026
Blue Cross Blue Shield of Michigan is issuing clinical guidance on implementing measurement-based care (MBC) for depression, anxiety, and suicide risk assessment using validated screening instruments (PHQ-9, GAD-7, etc.). This is an informational/educational policy from Dr. Beecroft emphasizing best practices for routine symptom monitoring and the DSF-E HEDIS measure requirements for depression screening and follow-up within 30 days. No specific billing code changes, coverage denials, or prior authorization requirements are introduced.
Medium impact
Select Medicare Advantage members will receive kidney health evaluation, A1c test kits from LetsGetChecked in early July
BCBS Michigan·Effective Jul 1, 2026
Blue Cross Blue Shield of Michigan and Blue Care Network will distribute no-cost, in-home test kits (eGFR, uACR, and/or A1c tests) to select Medicare Advantage members with diabetes in early July 2026 to improve compliance with the KED (Kidney Health Evaluation for Patients with Diabetes) HEDIS measure. Billing teams should be aware that test results will be communicated to members via mail, phone, and certified letter (if abnormal), and to providers via Direct Trust messaging or fax, requiring coordination with primary care providers for result discussion.
High impact
Pharmacy news roundup
BCBS Michigan·Identified Jun 26, 2026
This is a pharmacy news roundup from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) summarizing multiple pharmacy-related policy changes effective between June and September 2026. Key changes include: prior authorization requirements for Immgolis Intri IV (June 1), additional drugs for Medicare Advantage (July 1), CGM product eligibility verification for University of Michigan employers, radiopharmaceutical management through oncology programs (Sept 1), and new medical oncology drug requirements (Aug 12). Practices must review each linked alert for specific billing code impacts.
Low impact
Streamlined process for first-time access to the WellSky provider portal through Availity Essentials
BCBS Michigan·Effective Jul 1, 2026
Blue Cross Blue Shield of Michigan and Blue Care Network have simplified first-time access to the WellSky provider portal through Availity Essentials. Providers no longer need to obtain an AKA ID or complete a manual access request form; they can now access the portal directly by clicking the WellSky Authorization Portal tile in the Applications tab. This streamlines the onboarding process for prior authorization submissions.
High impact
Last chance: Q&A session to learn about changes for Medicare Advantage home health care managed by tango
BCBS Michigan·Effective Mar 1, 2026
Tango (a third-party administrator) now manages referrals, prior authorizations, and claims processing for home health care services under Medicare Advantage plans (Medicare Plus Blue and BCN Advantage) effective March 1, 2026. Blue Cross Blue Shield of Michigan and Blue Care Network are hosting a final Q&A session on July 15, 2026, and providers must transition to the tango operation model using the ProNet Connect provider portal.
Medium impact
Referrals to home healthcare for Medicare Advantage members: Grace period extended through Sept. 30 for acute care providers
BCBS Michigan·Effective Sep 30, 2026
Blue Cross Blue Shield of Michigan has extended the grace period for home healthcare referrals for Medicare Advantage members from May 31, 2026, through September 30, 2026. During this extension, acute care providers do not need to submit referrals directly to tango; home healthcare providers can continue submitting referral requests directly to tango. This delay gives providers additional time to transition to tango's operational model and complete necessary connections.
High impact
Register for training about prior authorization changes for radiation oncology, radiopharmaceuticals
BCBS Michigan·Effective Sep 1, 2026
Effective September 1, 2026, radiation oncology services (including proton beam therapy) and radiopharmaceuticals will be managed through the Oncology Value Management program administered by OncoHealth. This represents a shift in prior authorization requirements and management for these services. OncoHealth is hosting training webinars in August and September 2026 to educate providers on the new program.
High impact
We’re adding requirements for additional medical oncology drugs for most members, starting Aug. 12
BCBS Michigan·Effective Aug 12, 2026
Blue Cross Blue Shield of Michigan is adding prior authorization, site of care, and step therapy requirements for 7 medical oncology drugs administered in outpatient settings, effective August 12, 2026. These drugs are managed through the Oncology Value Management program and affect commercial, Medicare Advantage, and individual plan members. Billing teams must implement new prior authorization submission workflows to OncoHealth and update internal systems to reflect these requirements before the effective date.
High impact
Radiation oncology and radiopharmaceutical procedure codes to be managed through the Oncology Value Management program
BCBS Michigan·Effective Sep 1, 2026
Effective September 1, 2026, Blue Cross Blue Shield of Michigan is transferring management of all radiation oncology procedures and select radiopharmaceuticals from EviCore/Carelon to OncoHealth through the Oncology Value Management program. All affected radiation oncology and radiopharmaceutical claims will now require prior authorization through OncoHealth, with site-of-care requirements for commercial members receiving treatment in Michigan.
Medium impact
Time savings tips: Provider Level 1 Appeals for Blue Cross commercial claims
BCBS Michigan·Effective Jul 1, 2026
Blue Cross Blue Shield of Michigan has released proactive guidance to help providers avoid unnecessary Level 1 appeals for commercial claims by taking preliminary steps before appeal submission. Providers should verify eligibility via the Availity portal, call Provider Inquiry at 1-800-344-8525 within 180 days of claim determination, and submit medical documentation with the appeal cover sheet. This approach often resolves issues through reprocessing, billing error correction, or benefit updates without formal appeals.
Low impact
Well-managed chronic conditions can help members avoid ER visits, hospital stays
BCBS Michigan·Identified Jun 26, 2026
This is an informational policy from Blue Cross Blue Shield of Michigan (BCBSM) and FEP Blue emphasizing resources and support programs to help manage chronic conditions (diabetes, hypertension, cardiovascular disease) and reduce ER visits and hospital admissions. The policy provides providers with HEDIS tip sheets, training videos, and patient resources, along with member support services including telemedicine, disease management programs, and care coordination. No new billing requirements, coverage changes, or code updates are mandated.
Low impact
Submit your questions for Q&A sessions that focus on unique prospective editing topics
BCBS Michigan·Identified Jun 26, 2026
Blue Cross Blue Shield of Michigan is hosting Q&A sessions on prospective editing topics for providers. This is an informational announcement about educational opportunities, not a policy change affecting billing codes, coverage, or reimbursement. Providers are invited to submit questions by August 5, 2026, for the August 11 session.
Low impact
On-demand opportunities available for training
BCBS Michigan·Identified Jun 26, 2026
Blue Cross Blue Shield of Michigan and Blue Care Network are promoting on-demand training resources for providers, specifically highlighting a new InterQual® criteria in e-referral mini module to help providers submit prior authorization requests more efficiently. This is an educational announcement about training availability, not a coverage or billing policy change.
Low impact
Webinars for physicians, coders focus on documentation, coding
BCBS Michigan·Identified Jun 26, 2026
Blue Cross Blue Shield of Michigan is offering a series of free educational webinars for physicians and coders throughout 2026 covering critical topics including coding and documentation best practices. These sessions are educational/informational in nature and do not represent billing policy changes, but attendance is recommended to stay current on coding updates and compliance requirements.
Medium impact
Coding Corner: Tips for documenting Major Depressive Disorder
BCBS Michigan·Identified Jun 26, 2026
This is a Blue Cross Blue Shield of Michigan coding guidance update emphasizing proper documentation standards for Major Depressive Disorder (MDD). Providers must document MDD with specific episode type (single vs. recurrent), severity level, clinical findings (e.g., PHQ-9 scores), and current treatment status rather than using vague terms like 'depression' or 'history of depression.' This ensures claims reflect accurate diagnosis coding and reduces claim denials due to insufficient documentation.

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Archive by year

2023 2024 2025 2026

July 16, 2024 Kaiser Permanente hospitals rated among nation’s best U.S. News &amp; World Report recognizes Kaiser Permanente’s medical facilities …

August 14, 2024 Kaiser Permanente improves member experience with AI-enabled clinical technology Assisted clinical documentation tool from Abridge helps doctors reduce …

October 23, 2024 Kaiser Permanente partners with Atlanta Hawks to promote health and wellness Organization becomes the NBA team’s official health plan provider.

December 11, 2024 Kaiser Permanente Portland hospitals named Best Hospitals for Maternity Care Sunnyside and Westside medical centers have been named to U.S. News &amp; World …

July 29, 2025 Kaiser Permanente hospitals named among best in nation U.S. News &amp; World Report recognizes Kaiser Permanente’s medical facilities …

August 15, 2025 Nationally recognized for high-quality cardiovascular care The American Heart Association presents Get With The Guidelines® awards …

MTM Health To Provide Medical Transportation for Medicaid Members

[Indiana] Save the Date: July 2026 Live Provider Orientation

Do you know about our BlueCard processes?

New FAQ on electronic medical record connectivity is now available

Dr. Beecroft: Using measurement-based care in depression, anxiety and suicide risk to improve outcomes

Select Medicare Advantage members will receive kidney health evaluation, A1c test kits from LetsGetChecked in early July

Pharmacy news roundup

Streamlined process for first-time access to the WellSky provider portal through Availity Essentials

Last chance: Q&A session to learn about changes for Medicare Advantage home health care managed by tango

Referrals to home healthcare for Medicare Advantage members: Grace period extended through Sept. 30 for acute care providers

Register for training about prior authorization changes for radiation oncology, radiopharmaceuticals

We’re adding requirements for additional medical oncology drugs for most members, starting Aug. 12

Radiation oncology and radiopharmaceutical procedure codes to be managed through the Oncology Value Management program

Time savings tips: Provider Level 1 Appeals for Blue Cross commercial claims

Well-managed chronic conditions can help members avoid ER visits, hospital stays

Submit your questions for Q&A sessions that focus on unique prospective editing topics

On-demand opportunities available for training

Webinars for physicians, coders focus on documentation, coding

Coding Corner: Tips for documenting Major Depressive Disorder

July 16, 2024 Kaiser Permanente hospitals rated among nation’s best U.S. News & World Report recognizes Kaiser Permanente’s medical facilities …

December 11, 2024 Kaiser Permanente Portland hospitals named Best Hospitals for Maternity Care Sunnyside and Westside medical centers have been named to U.S. News & World …

July 29, 2025 Kaiser Permanente hospitals named among best in nation U.S. News & World Report recognizes Kaiser Permanente’s medical facilities …