All Insurance Policy Changes (Page 28)

Continuing from page 27. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
Make sure your data is current in the National Plan & Provider Enumeration System
UPMC Health Plan·Identified Aug 7, 2026
UnitedHealth Care is reminding providers that they are legally required to maintain current and accurate National Provider Identifier (NPI) data in the NPPES system. Providers must review their NPI records immediately to ensure all information is accurate and up-to-date, as outdated provider data can impact claims processing and network status.
Low impact
September is National Recovery Month & earn CME credits on a timely webinar series
UPMC Health Plan·Identified Aug 7, 2026
UPMC Health Plan is offering a free, CME-accredited four-part webinar series on substance use disorder management during National Recovery Month (September). This is an educational opportunity for providers to earn continuing medical education credits by completing recorded modules on screening, alcohol use disorder, opioid use disorder, and available resources. No billing or coding changes are required.
Low impact
Drug recall: Voluntary Nationwide Recall: Tydemy (Lupin July)
UPMC Health Plan·Identified Aug 7, 2026
Lupin Pharmaceuticals has issued a voluntary nationwide recall of two lots of Tydemy (a contraceptive/prenatal vitamin combination) due to failed stability testing that could reduce product effectiveness and result in unintended pregnancy. Billing teams should be aware that affected patients may seek alternative contraceptive products, and providers should verify lot numbers before dispensing.
High impact
Drug recall: Voluntary nationwide recall: Digoxin
UPMC Health Plan·Identified Aug 7, 2026
⚠️ CONTENT MISMATCH DETECTED: Policy titled 'Drug recall: Voluntary nationwide recall: Digoxin' contains no information about digoxin recall, pharmacy actions, or billing impacts. Instead, the policy body describes a CME webinar on intimate partner violence (IPV). This appears to be a content error or system misconfiguration. The billing team cannot take action until the correct policy content is provided.
Medium impact
Voluntary nationwide recall: Cyclosporine
UPMC Health Plan·Effective Oct 6, 2023
Novartis has issued a voluntary nationwide recall of one lot of Sandimmune Oral solution (cyclosporine oral solution, USP), 100 mg/mL, due to crystal formation in some bottles. This medication is used to prevent organ rejection in transplant patients. The billing team must be aware of this recall to handle any patient inquiries, potential claim adjustments, or alternative medication substitutions that may occur.
Medium impact
Voluntary nationwide recall: Sucralfate
UPMC Health Plan·Effective Oct 6, 2023
VistaPharm LLC has issued a voluntary nationwide recall of one lot of Sucralfate Oral Suspension (1 g/10 mL) due to Bacillus cereus contamination. This is a pharmacy safety alert requiring immediate notification to patients and providers who may have received the affected lot to prevent potential adverse events from contaminated anti-ulcer medication.
Low impact
UPMC begins sharing biometric screening results for its new employees with consent
UPMC Health Plan·Effective Sep 1, 2023
UPMC is now sharing biometric screening results (titers, cholesterol, triglycerides, glucose) from new employee preplacement exams with their primary care physicians, effective September 2023, with employee consent. PCPs will receive results via Quest Quanum through their preferred contact method or via fax if no method is on file.
High impact
Voluntary nationwide recall: Brexafemme
UPMC Health Plan·Identified Aug 7, 2026
Scynexis, Inc. has issued a voluntary nationwide recall of two lots of Brexafemme (ibrexafungerp tablets) due to potential cross-contamination with a non-antibacterial ß-lactam drug substance. Billing teams must immediately identify and flag any claims for affected lot numbers and coordinate with providers to halt dispensing and notify patients.
High impact
Voluntary nationwide recall: Betaxolol
UPMC Health Plan·Effective Sep 29, 2023
KVK-Tech Inc. is recalling Betaxolol tablets USP 10 mg (NDC 10702-0013-01, lot 17853A, expiry 06/2027) due to contamination with Oxycodone HCl tablets found during packaging. This is a pharmacy/medication safety recall affecting patients on hypertension treatment. The billing team must identify affected prescriptions and coordinate with providers and patients for medication replacement.
High impact
Nursing facility ineligible reassessment and certification forms (MA570)
UPMC Health Plan·Identified Aug 7, 2026
Pennsylvania's Community HealthChoices program now requires physicians to complete and return the MA570 certification form within 14 days of receipt to maintain patient eligibility for home- and community-based services. Failure to submit this form timely will result in delays or disruption of Medicaid coverage and may force patients into institutional settings. The form must specify the appropriate level of care (NFCE, NFI, or ICF/ORC) and be signed by an MD or DO.
High impact
Voluntary nationwide recall: Exela Pharma (October)
UPMC Health Plan·Effective Oct 1, 2023
Exela Pharma is voluntarily recalling multiple lots of 8.4% Sodium Bicarbonate Injection, USP (NDC: 51754-5001-04) due to silicone particles contaminating the product. Silicone particles can cause local irritation, blood vessel blockage, stroke, and death if administered. Billing teams must identify and halt claims for affected lots, ensure providers stop using recalled inventory, and coordinate with pharmacy and clinical staff to prevent patient administration.
Medium impact
Provider diagnosis documentation: Updates to Medicare Risk Adjustment/HCC
UPMC Health Plan·Effective Jan 24, 2024
UPMC Health Plan is hosting a CME-accredited educational webinar on January 24, 2024, to train providers on updated Medicare Advantage risk adjustment and HCC coding documentation requirements. The session covers diagnosis documentation best practices, ICD-10-CM coding specificity, and CMS updates to the Medicare Advantage risk adjustment model to improve accurate code reporting.
Low impact
Earn CME credits and support your patients' mental health
UPMC Health Plan·Identified Aug 7, 2026
UPMC Health Plan is offering free CME courses on mental health topics (suicide/depression screening in primary care and 988 National Suicide Prevention Lifeline) to providers. This is an educational initiative, not a billing or coverage policy change. No workflow modifications are required for the billing team.
Low impact
Provider OnLine improvements coming in early 2024
UPMC Health Plan·Effective Jan 1, 2024
UnitedHealthcare Provider OnLine portal will receive significant usability and functionality updates starting in early 2024, including improved eligibility information access, enhanced security management, faster search speeds, and better navigation. The billing team should familiarize themselves with these changes to streamline provider account access and member eligibility verification workflows.
Low impact
The 988 Suicide & Crisis Lifeline adds nationwide ASL services for Deaf and Hard of Hearing callers
UPMC Health Plan·Identified Aug 7, 2026
The 988 Suicide & Crisis Lifeline has expanded to include nationwide American Sign Language (ASL) services for Deaf, Hard of Hearing, and related populations. Callers can access ASL-trained counselors via 988lifeline.org or by calling 1-800-273-TALK (8255) from a videophone, with direct dialing to 988 from videophone coming soon. This is an informational announcement about expanded mental health crisis services and does not create new billing or coding requirements for healthcare providers.
Low impact
Voluntary nationwide recall: Eye drops (Leader)
UPMC Health Plan·Identified Aug 7, 2026
Cardinal Health Inc. has issued a voluntary nationwide recall of certain lots of Leader brand over-the-counter eye drops due to bacterial contamination that could cause eye infections resulting in partial vision loss or blindness. This is a product safety recall, not a billing policy change, but the billing team should be aware for potential claim adjustments or patient communications if affected patients seek treatment for complications.
Medium impact
Voluntary nationwide recall: Eye drops (Rugby)
UPMC Health Plan·Effective Oct 31, 2023
The Harvard Drug Group LLC has issued a voluntary nationwide recall of certain lots of Rugby brand eye drops due to bacterial contamination that could cause eye infections resulting in partial vision loss or blindness. As of October 31, 2023, three adverse events have been reported. The billing team must ensure affected patients are identified and that claims for recalled product lots are handled appropriately per payer guidance.
Medium impact
Prescription for Wellness order set updates
UPMC Health Plan·Effective Nov 29, 2023
Effective Nov. 29, 2023, UPMC's Prescription for Wellness order set has been expanded to include a new 'Diabetes & Metabolic Health' category with three service components (Certified Diabetes Care & Education Specialist, Diabetes Health Coaching, and Diabetes Prevention Program) and added 'Employment' as a topic under Patient/Family Support Services. The billing team must ensure these new wellness services are properly coded and billed under the updated order set guidelines.
High impact
Musculoskeletal procedures update
UPMC Health Plan·Effective Feb 1, 2024
Effective February 1, 2024, UPMC Health Plan is implementing prior authorization requirements for eight categories of musculoskeletal procedures, including wrist and ankle arthroscopy, bunionectomy, arthrodesis, plantar fascia release, and radius/ulna fracture fixation. All claims for these procedures must obtain prior authorization using InterQual Connect criteria before services are rendered to avoid denial.
Low impact
CME webinar: ADHD Practice Guidelines
UPMC Health Plan·Identified Aug 7, 2026
This is a CME webinar announcement from UPMC Health Plan scheduled for April 17, offering continuing medical education credits on ADHD practice guidelines, HEDIS quality metrics, and pharmacy-related insights for ADHD medication prescribing. This is an educational offering, not a policy change affecting billing or coverage.
Medium impact
Mandatory training for Medicare SNP providers
UPMC Health Plan·Effective Feb 29, 2024
CMS requires all providers serving Medicare Special Needs Plan (SNP) members to complete annual Model of Care (MOC) training. UPMC Health Plan has developed an online training module accessible at upmchp.us/snpmoc that must be completed and attested to by February 29, 2024. This is a mandatory compliance requirement for all SNP providers.
Medium impact
Flu, RSV, and COVID-19 vaccine recommendations: Fall and winter 2023–2024
UPMC Health Plan·Effective Dec 5, 2023
UPMC Health Plan has updated vaccine coverage recommendations for fall/winter 2023-2024, establishing new reimbursement guidelines for flu, RSV, and COVID-19 vaccines across all age groups. Billing teams must verify patient eligibility for specific vaccines (Beyfortus for infants, RSV vaccines for adults 60+, updated COVID-19 formulations) and apply appropriate cost-sharing based on ACIP recommendations and network status. Claims submitted without adherence to these recommendations may result in denials or member cost-share application.
Low impact
Coming soon: LGBTQIA+ Affirming Provider Designation toolkits
UPMC Health Plan·Identified Aug 7, 2026
UnitedHealthcare is distributing LGBTQIA+ Affirming Provider Designation toolkits (welcome letter, postcard, badge reel, lapel pin, table tent, talking points) to providers who have already earned the designation. This is an informational announcement about physical materials shipment requiring signature delivery. Providers interested in earning the designation must complete three online modules covering transgender/gender-diverse/intersex patient care, sexual orientation and gender identity affirming documentation, and LGBTQIA+ awareness.
Medium impact
Review our commercial product billing guide
UPMC Health Plan·Effective May 1, 2023
Pennsylvania Act 1 of 2023 requires commercial insurance plans to cover one supplemental breast screening per year for women at increased risk of breast cancer via MRI or ultrasound. UPMCHealthPlan has released this policy update with billing guidance recommendations to help providers comply with the new state mandate.
Low impact
CME webinar: Antimicrobial Stewardship in Outpatient Settings
UPMC Health Plan·Identified Aug 7, 2026
This is an educational announcement for a CME-accredited webinar on antimicrobial stewardship in outpatient settings scheduled for February 28, 2024. The policy does not contain billing code changes, coverage modifications, or reimbursement adjustments that would impact medical billing operations.

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Archive by year

2023 2024 2025 2026

Make sure your data is current in the National Plan & Provider Enumeration System

September is National Recovery Month & earn CME credits on a timely webinar series

Drug recall: Voluntary Nationwide Recall: Tydemy (Lupin July)

Drug recall: Voluntary nationwide recall: Digoxin

Voluntary nationwide recall: Cyclosporine

Voluntary nationwide recall: Sucralfate

UPMC begins sharing biometric screening results for its new employees with consent

Voluntary nationwide recall: Brexafemme

Voluntary nationwide recall: Betaxolol

Nursing facility ineligible reassessment and certification forms (MA570)

Voluntary nationwide recall: Exela Pharma (October)

Provider diagnosis documentation: Updates to Medicare Risk Adjustment/HCC

Earn CME credits and support your patients' mental health

Provider OnLine improvements coming in early 2024

The 988 Suicide & Crisis Lifeline adds nationwide ASL services for Deaf and Hard of Hearing callers

Voluntary nationwide recall: Eye drops (Leader)

Voluntary nationwide recall: Eye drops (Rugby)

Prescription for Wellness order set updates

Musculoskeletal procedures update

CME webinar: ADHD Practice Guidelines

Mandatory training for Medicare SNP providers

Flu, RSV, and COVID-19 vaccine recommendations: Fall and winter 2023–2024

Coming soon: LGBTQIA+ Affirming Provider Designation toolkits

Review our commercial product billing guide

CME webinar: Antimicrobial Stewardship in Outpatient Settings