All Insurance Policy Changes (Page 146)

Continuing from page 145. 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
Feature Stories Highlight Physician Collaborations and Innovations
Horizon BCBS NJ·Effective Sep 1, 2022
This is a Horizon Blue provider news bulletin from September 2022 featuring multiple updates including new authorization features in their eligibility tools, guidance on diagnosis coding specificity, and Trinitas Regional Medical Center's designation as an OMNIA Tier 1 hospital. Key actionable items include utilizing the new Authorizations feature in the Member Eligibility and Benefits Cost Share Estimator, submitting specific diagnosis codes to prevent denials, and updating facility networks for Trinitas.
Medium impact
Doula Services for Individual Health Coverage (IHC) Members — Helping to Improve Outcomes
Horizon BCBS NJ·Identified Jun 26, 2026
Failed to analyze policy change
Low impact
Horizon Introduces Local Support to Close Member Care Gaps
Horizon BCBS NJ·Identified Jun 26, 2026
This is a table of contents/news digest from Horizon Blue's March 2023 Blue Review publication covering multiple operational topics including demographic data updates, coding and documentation improvements, electronic document handling, recredentialing requirements, and new member support initiatives. No specific billing policy change is detailed in the provided content.
Low impact
Behavioral Health Patient Resources – We can Help
Horizon BCBS NJ·Identified Jun 26, 2026
This is a June 2023 Horizon Blue informational resource document covering multiple behavioral health and administrative topics including care coordination, metabolic monitoring, prior authorization processes, and billing workflows. It does not announce specific policy changes affecting billing codes, coverage, or reimbursement rates.
Medium impact
Helping Members Get Care: In-Home Assessments to Close Care Gaps
Horizon BCBS NJ·Effective Nov 1, 2023
Horizon Blue is implementing in-home assessments to close care gaps for members, with multiple concurrent updates including new Provider Portal (Availity Essentials), Provider Services call center hours changes, and policy updates for biosimilars, behavioral health services, and member access initiatives. This is a comprehensive policy update affecting multiple operational and clinical areas.
Medium impact
Horizon’s HIE to end in 2024
Horizon BCBS NJ·Effective Dec 31, 2024
Horizon Blue Cross Blue Shield is discontinuing its Health Information Exchange (HIE) service by the end of 2024. Billing and clinical teams must identify alternative methods for exchanging patient health information and medical records with Horizon, as this service will no longer be available.
Low impact
Get Started with our New Provider Portal, Availity Essentials
Horizon BCBS NJ·Identified Jun 26, 2026
Horizon Blue has launched Availity Essentials, a new provider portal with self-service tools for faster access to patient information, medical records management via HorizonDocs, and appeals processing. This is an administrative/operational update requiring provider familiarity with the new portal system, but does not change billing codes, prior authorization requirements, or coverage policies.
Medium impact
Availity Essentials Is Your New Provider Portal
Horizon BCBS NJ·Identified Jun 26, 2026
Horizon Blue Cross Blue Shield has launched Availity Essentials as the new provider portal, replacing previous portal access. This is an operational/administrative change requiring providers and billing staff to migrate to the new portal for claims submission, prior authorization, and medical records management. The policy also contains multiple clinical and quality-related updates for June 2024.
Medium impact
2024 FEP Provider Quality Incentive Program to Close Gaps in Care
Horizon BCBS NJ·Identified Jun 26, 2026
Failed to analyze policy change
Medium impact
Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) and Concurrent Use of Opioids and Benzodiazepines (COB)
Horizon BCBS NJ·Identified Jun 26, 2026
This is a policy announcement from Horizon Blue (December 2024) introducing clinical guidelines and monitoring initiatives for polypharmacy involving multiple anticholinergic medications in older adults (Poly-ACH) and concurrent use of opioids and benzodiazepines (COB). The policy emphasizes primary care coordination, patient engagement, and compliance tracking but does not specify immediate billing changes or prior authorization requirements in the provided content.
Medium impact
Credentialing and Recredentialing Administrative Policy Updates: Changes to Hospital Admitting Privileges
Horizon BCBS NJ·Identified Jun 26, 2026
Failed to analyze policy change
Low impact
Getting the Right Care at the Right Place
Horizon BCBS NJ·Identified Jun 26, 2026
This is a Horizon Blue June 2025 provider newsletter containing multiple operational updates and resources across billing, behavioral health, pharmacy, and patient care coordination. Key topics include online authorization submissions, medical records management via HorizonDocs, pediatric specialist referrals, senior care coordination, and opioid abuse prevention resources. No specific billing code changes or coverage modifications are detailed in this content.
Low impact
Tips for Checking Member Eligibility and Benefits and Claim Status Inquiry Transactions
Horizon BCBS NJ·Identified Jun 26, 2026
This is a Blue Review December 2025 resource compilation covering best practices for member eligibility verification, claims submission, care gap closure, vaccination initiatives, and patient experience improvements. It includes updates on Availity Essentials integration, pharmacy resources (Amazon Pharmacy), antipsychotic medication monitoring, and cultural competency training. No specific billing code changes, prior authorization requirements, or reimbursement adjustments are detailed in this overview document.
Medium impact
Federal Employee Program (FEP) Quality Program 2026 Launch
Horizon BCBS NJ·Effective Mar 1, 2026
This is a comprehensive policy update announcement from Horizon Blue covering multiple 2026 initiatives including the Federal Employee Program (FEP) Quality Program launch, mandatory patient safety attestations, new training webinars, medical policy updates, BlueCard program changes, HEDIS measures implementation, and clinical guidelines. The policy emphasizes quality measures, gap closure, risk adjustment, and standardized clinical tools across multiple payer programs.
Medium impact
Submit Prior Authorization for Your Patient's Medications Quickly and Easily Using ePA
Horizon BCBS NJ·Effective Sep 1, 2025
Horizon Blue has launched ePA (electronic Prior Authorization) as a streamlined tool for submitting medication prior authorizations. This new resource enables providers to request prior authorization for patient medications more quickly and easily through an electronic platform, reducing administrative burden and potentially improving authorization turnaround times.
High impact
Opioids and CGMs may not need a PA
Missouri Medicaid (MO HealthNet)·Effective Feb 27, 2023
MO HealthNet eliminates prior authorization requirements for opioid prescriptions under 50 MME per day and for Dexcom CGM devices for insulin-dependent patients. Opioid-naive patients still require a 7-day fill prior to full 30-day prescriptions. Dexcom CGM auto-approves at pharmacy for eligible participants with recent rapid/short-acting insulin fills, requiring no additional paperwork from providers.
High impact
The 2022 - 2023 Respiratory Syncytial Virus (RSV) season is winding down
Missouri Medicaid (MO HealthNet)·Effective Feb 28, 2023
Missouri HealthNet (MHD) is ending prior authorization requirements for Synagis (RSV prophylaxis) effective February 28, 2023, and will no longer cover any Synagis doses administered after this date. This change reflects the early conclusion of the 2022-2023 RSV season in Missouri, with RSV virology positivity dropping below 3%.
High impact
COVID-19: 1135 Waiver for Pre-Admission Screening and Resident Review (PASRR)
Missouri Medicaid (MO HealthNet)·Effective May 12, 2023
The COVID-19 Public Health Emergency waiver for PASRR (Preadmission Screening and Resident Review) expires on May 11, 2023. Effective May 12, 2023, MO HealthNet requires all participants with qualifying mental illness or intellectual disability diagnoses seeking admission to Medicaid-certified nursing facility beds to complete a Level I evaluation and obtain Level II review by state mental health authority before admission. This restores the pre-waiver screening requirement for nursing home admissions.
Low impact
It's almost time for HealthHelp's Provider Satisfaction Survey
Missouri Medicaid (MO HealthNet)·Effective Jun 13, 2023
HealthHelp, the Radiology Benefits Manager for MO HealthNet Division, is conducting a Provider Satisfaction Survey beginning June 13, 2023. This is a voluntary feedback initiative to improve authorization processes, not a billing or coverage policy change. No billing workflow modifications are required.
Low impact
Aggression Management for Youth Training
Missouri Medicaid (MO HealthNet)·Identified Jun 26, 2026
This is a training announcement for the Missouri Child Psychiatry Access Project (MO-CPAP) on aggression management for youth, scheduled for May 12, 2026. This is an educational event notification, not a billing policy change, and does not affect claims processing, coding, or reimbursement workflows.
Medium impact
Crossover Claims and Hospice Care
Missouri Medicaid (MO HealthNet)·Effective Jun 20, 2026
MHD implemented a system change on June 20, 2026, to automatically process crossover claims for Medicare Advantage (Part C) participants who receive hospice care during a month. Previously, these claims were denied and required manual intervention via fax or phone. Providers no longer need to contact the Medicare unit for assistance—claims will now process automatically.
High impact
MO HealthNet Coverage Ending for Some Services
Missouri Medicaid (MO HealthNet)·Effective Jul 1, 2026
Effective July 1, 2026, MO HealthNet is terminating reimbursement for acupuncture, chiropractic, and physical therapy services under the Complementary Health and Alternative to Chronic Pain Management program, plus all chiropractic services statewide. All claims for these services submitted after June 30, 2026, will be denied. Practices must immediately identify affected patients and stop billing these services to MO HealthNet.
High impact
Scaling and Root Planning Services
Missouri Medicaid (MO HealthNet)·Effective Jun 25, 2026
MO HealthNet Division (MHD) clarifies that Scaling and Root Planning (SRP) services do NOT require prior authorization and establishes specific clinical eligibility criteria and frequency limits (one quadrant per two years). Additionally, code D4346 (full mouth scaling with inflammation) is now reimbursable with strict limitations on documentation, billing combinations, and timing restrictions relative to prophylaxis and other periodontal procedures.
Medium impact
Personal Care Provider Manual Update
Missouri Medicaid (MO HealthNet)·Identified Jun 26, 2026
Failed to analyze policy change
Medium impact
Pharmacy coverage changes
Harvard Pilgrim Health Care·Effective Nov 1, 2025
Point32Health updated prior authorization coverage criteria for two specialty kidney disease medications (Filspari and Tarpeyo) effective November 1, 2025. Both drugs now require documented proteinuria ≥1 g/day and a mandatory 3-month trial of first-line therapies (ACEi, ARB, SGLT2i, and supportive care) before approval. Filspari has an additional contraindication restriction prohibiting concurrent use with ACEi, ARB, endothelin receptor antagonist, or aliskiren.

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Insurance Policy Changes Tracker: All Payer Updates (Page 146) | PolicyChanges.app

Feature Stories Highlight Physician Collaborations and Innovations

Doula Services for Individual Health Coverage (IHC) Members — Helping to Improve Outcomes

Horizon Introduces Local Support to Close Member Care Gaps

Behavioral Health Patient Resources – We can Help

Helping Members Get Care: In-Home Assessments to Close Care Gaps

Horizon’s HIE to end in 2024

Get Started with our New Provider Portal, Availity Essentials

Availity Essentials Is Your New Provider Portal

2024 FEP Provider Quality Incentive Program to Close Gaps in Care

Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) and Concurrent Use of Opioids and Benzodiazepines (COB)

Credentialing and Recredentialing Administrative Policy Updates: Changes to Hospital Admitting Privileges

Getting the Right Care at the Right Place

Tips for Checking Member Eligibility and Benefits and Claim Status Inquiry Transactions

Federal Employee Program (FEP) Quality Program 2026 Launch

Submit Prior Authorization for Your Patient's Medications Quickly and Easily Using ePA

Opioids and CGMs may not need a PA

The 2022 - 2023 Respiratory Syncytial Virus (RSV) season is winding down

COVID-19: 1135 Waiver for Pre-Admission Screening and Resident Review (PASRR)

It's almost time for HealthHelp's Provider Satisfaction Survey

Aggression Management for Youth Training

Crossover Claims and Hospice Care

MO HealthNet Coverage Ending for Some Services

Scaling and Root Planning Services

Personal Care Provider Manual Update

Pharmacy coverage changes