All Insurance Policy Changes (Page 4)

Continuing from page 3. 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
New to Availity Essentials or looking to sharpen your skills?
Ambetter·Identified Sep 12, 2026
Availity has launched enhanced training resources through the Availity Learning Center to help providers optimize use of Availity Essentials. This is an informational bulletin announcing available training options, including live webinars scheduled for October 2026 covering pre-service and post-service workflows, along with on-demand training modules.
Low impact
New to Availity Essentials or looking to sharpen your skills?
Ambetter·Identified Sep 12, 2026
Availity Essentials has launched an enhanced Learning Center with flexible training options including live webinars and on-demand courses. The billing team should be aware that plan-specific training for CNC health plans and general Availity training sessions are now available, with live webinars scheduled for October 6 (pre-service workflow) and October 8 (post-service workflow) covering eligibility, authorizations, claim submission, and remittance processes.
High impact
Auth Submissions Temporarily Unavailable via Availity Sept. 18-21
Highmark·Effective Sep 18, 2026
Highmark will perform planned systems maintenance on the Availity Essentials portal from Friday, September 18 at 9 p.m. to Monday, September 21 at 6 a.m. ET. During this blackout window, providers cannot submit electronic authorization requests or view existing authorizations via Availity; urgent requests must be submitted by fax instead.
Medium impact
Enhanced portal functionality offers increased efficiency
Harvard Pilgrim Health Care·Effective Oct 2, 2026
Point32Health is expanding the MHK portal functionality for Tufts Health Plan Senior Care Options (SCO) members, enabling providers to submit behavioral health and medical prior authorization requests and inpatient notifications electronically with real-time determinations starting October 2, 2026. This eliminates the need for phone or manual submissions for these request types, though care manager notifications for certain procedures must still be handled via phone.
Medium impact
Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials
BCBS Illinois·Effective Dec 11, 2026
Blue Cross Blue Shield of Illinois is transitioning Medicare Advantage prior authorization approval letters from U.S. Postal Service mail to digital-only delivery via Availity Essentials Provider Correspondence Viewer, effective December 11, 2026. Denial letters will continue to be mailed but will also be available digitally. Prior authorizations from third-party vendors will remain on existing channels.
High impact
Voluntary nationwide recall: Sodium Chloride (Baxter – August 2026)
UPMC Health Plan·Identified Sep 12, 2026
Baxter International is recalling two lots (Y495523 and Y495523A) of 0.9% Sodium Chloride Injection due to fiberglass particle contamination that poses risk of local irritation, swelling, and life-threatening blood clots. Billing teams must identify affected patients, coordinate with providers and pharmacies to halt use, and document any related claims or adverse events for potential adjustments.
High impact
Voluntary nationwide recall: Sodium Chloride (B. Braun – August 2026)
UPMC Health Plan·Identified Sep 12, 2026
B. Braun Medical Inc. is recalling three lots of 0.9% Sodium Chloride Injection USP (100 mL) due to iron oxide particles in the solution that could cause local irritation, swelling, or life-threatening blood clots. The billing team must identify claims involving these recalled lots and coordinate with providers and patients to halt use and prevent billing for potentially harmful products.
Medium impact
Voluntary nationwide recall: Dextrose (Baxter – August 2026)
UPMC Health Plan·Identified Sep 12, 2026
Baxter International is recalling one lot (Y495066) of 70% Dextrose Injection due to stainless steel particles that could cause local irritation, swelling, or life-threatening blood clots. The billing team must identify claims associated with this recalled lot, communicate with providers and patients, and potentially process adjustments or denials for affected administrations. As of August 25, 2026, no adverse events have been reported.
Medium impact
Voluntary nationwide recall: Thyroid (Vitruvias – August 2026)
UPMC Health Plan·Identified Sep 12, 2026
Vitruvias Therapeutics Inc. has issued a voluntary nationwide recall of Thyroid Tablets, USP 30 mg, lot 504950, due to superpotency that may cause hyperthyroidism. This is a pharmacy safety alert requiring medical billing and clinical staff to identify affected patients, coordinate with providers and pharmacies, and ensure no disruption to patient care. No billing code changes are required, but practices must be aware for patient safety and potential follow-up claims related to adverse events or medication adjustments.
Low impact
CME Webinar: Lifestyle Medicine in Practice: Evidence‑Based Strategies for Chronic Disease Care
UPMC Health Plan·Identified Sep 12, 2026
This is a CME educational webinar announcement on lifestyle medicine scheduled for September 23, 2026. This is an informational/educational notice, not a billing policy change. No billing codes, coverage rules, or reimbursement changes are affected.
Medium impact
Attention All Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Providers: DMEPOS Enrollment Moratorium Has Ended
Nevada Medicaid·Effective Aug 28, 2026
Nevada Medicaid has ended its six-month moratorium on DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) provider enrollments effective August 27, 2026. New DMEPOS enrollment applications submitted on or after August 28, 2026 will now be processed according to standard federal and state policies. This reopens the enrollment pathway for DMEPOS providers in Nevada who were previously unable to enroll during the moratorium period.
High impact
Further Clarification of Certain Billing Procedures for Substance Use Treatment Services
Nevada Medicaid·Effective Sep 11, 2026
Nevada Medicaid clarifies that members receiving residential substance use treatment at ASAM levels 3.1, 3.5, or 3.7 (PT 93 providers) cannot simultaneously bill outpatient SUD services on the same date of service, except on admission and discharge dates. A specific list of outpatient codes is prohibited from being billed concurrently with residential SUD codes to eliminate duplicative billing.
Medium impact
Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials
BCBS Texas·Effective Oct 8, 2026
Beginning October 8, 2026, Medicare Advantage prior authorization decision letters will be available digitally through Availity Essentials' Provider Correspondence Viewer. Starting December 11, 2026, approval letters will no longer be mailed via USPS—digital access only. Denial letters will continue to be mailed but will also be available digitally. Providers should prepare to access and manage prior authorization documentation through the digital portal.
High impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota·Effective Nov 10, 2026
BCBSND released comprehensive pharmacy policy updates effective November 10, 2026, affecting 15+ medications with changes to prior authorization criteria, billing codes (HCPCS additions/discontinuations), ICD-10 coding, and clinical guidelines alignment. Multiple HCPCS codes transition on October 1, 2026 (J3590 discontinued, new codes J3590 replacements and J9066 added). Billing teams must update systems for new biosimilar products (Ponlimsi, denosumab-adet, Omlyclo, Avyxa) and discontinued codes before the effective dates.
Medium impact
2027 Change Notification Series: Sept. 10
Blue Cross Blue Shield of North Dakota·Effective Jan 1, 2027
Blue Cross Blue Shield of North Dakota (BCBSND) is implementing a comprehensive system and policy migration for commercial members effective January 1, 2027. Product and benefit changes, along with care management program updates, will take effect during this transition. Detailed information is available on the Provider Support Hub, and additional announcements will follow through September 2026.
Medium impact
5160-4-02.3 - Exception for certain services provided by residents. (Amend/Original File)
Ohio Medicaid·Effective Oct 13, 2026
Ohio Medicaid (5160-4-02.3) has amended its policy on exceptions for certain services provided by residents. The policy file date is 09/11/2026 with an effective date of 10/13/2026, but the actual policy content detailing what services are affected and what exceptions apply is not included in the provided document. Your billing team cannot implement this change without accessing the full rule body text.
High impact
Supplement 26-06: State of New Mexico Handicapping Labio-lingual Deviation (NM HLD) Index Report Form – MAD 908
New Mexico Medicaid·Effective Oct 1, 2026
New Mexico Medicaid requires providers to submit prior authorization requests for comprehensive orthodontic treatment using the standardized MAD 908 form (HLD Index Report Form) beginning October 1, 2026. Requests submitted without this form will be rejected and must be resubmitted, potentially resulting in claim denials.
High impact
Summer Provider Newsletter
South Dakota Medicaid·Effective Jan 1, 2027
South Dakota Medicaid is implementing major eligibility and coverage changes effective January 1, 2027, including new work requirements (80 hours/month community engagement) for Medicaid Expansion enrollees, more frequent eligibility renewals (every 6 months instead of 12 for Expansion codes 92-95), and reduced retroactive coverage (1 month for Expansion, 2 months for others). Billing teams must update patient verification workflows, verify eligibility at every visit, and ensure patients understand shorter renewal windows to prevent coverage gaps.
High impact
Claims Work Queue Inpatient Hospitals
South Dakota Medicaid·Identified Sep 12, 2026
South Dakota Medicaid now requires inpatient hospital claims for Care Management program recipients to include the referring provider's NPI in claim locators 78 or 79. A new Claims Work Queue portal feature allows providers to submit missing NPI information within 30 days without resubmitting the entire claim; claims without the referral NPI after 30 days will be denied.
Medium impact
Provider Letter 2026-15: Re: Provider Contract Processing Update
Oklahoma SoonerCare·Identified Sep 12, 2026
The Oklahoma Health Care Authority (OHCA) has announced a provider contract processing update addressing significant delays in contract reviews. They have reduced the backlog by 40% and expect to return to normal processing times by mid-October 2026. OHCA will establish a process for providers to resubmit claims that were previously denied due to delayed contract approvals.
Medium impact
New Limitation for Application of Caries Arresting Medicament for Texas Medicaid
Texas Medicaid·Effective Nov 1, 2026
Effective November 1, 2026, Texas Medicaid (TMHP) will deny claims for caries arresting medicament (D1354) when submitted within six months of a claim containing anesthesia procedure D9224. Billing teams must implement a six-month lookback requirement before processing D1354 claims to avoid denials.
Medium impact
OASIS for Administrators Trainings Set for September
Texas Medicaid·Identified Sep 12, 2026
This is an informational notice about mandatory OASIS training for home health agency administrators and alternate administrators. Two webinar sessions are scheduled for September 2026 (Part 1 on Sept 10, Part 2 on Sept 24). Completion provides administrator clock hours required for licensure compliance under Texas regulatory requirements (26 TAC Section 558.259).
High impact
System Maintenance Outage Scheduled for September 12–13, 2026
Texas Medicaid·Effective Sep 12, 2026
TMHP will conduct scheduled system maintenance on September 12–13, 2026, during which all web-based applications and functions will be unavailable for approximately 20.5 hours (6:30 a.m. Central Saturday through 3:00 a.m. Central Sunday). The billing team must plan ahead to avoid service disruptions during claims submission, eligibility verification, and other online portal activities.
Medium impact
Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials
BCBS Montana·Effective Oct 8, 2026
Blue Cross Medicare Advantage prior authorization approval letters will transition from U.S. Postal Service mail to digital-only delivery via Availity Essentials Provider Correspondence Viewer starting December 11, 2026. Beginning October 8, 2026, providers can access these letters digitally; denial letters will continue to be mailed while also available digitally. Prior authorizations from third-party vendors remain unaffected.
Medium impact
Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials
BCBS New Mexico·Effective Dec 11, 2026
Blue Cross Blue Shield of New Mexico is transitioning Medicare Advantage prior authorization approval letters from U.S. Postal Service mail to digital-only delivery via Availity Essentials Provider Correspondence Viewer, effective December 11, 2026. Beginning October 8, 2026, providers can access these letters digitally; denial letters will continue to be mailed and also available digitally. An opt-out option for mail delivery will be provided in future communications.

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Archive by year

2023 2024 2025 2026

New to Availity Essentials or looking to sharpen your skills?

New to Availity Essentials or looking to sharpen your skills?

Auth Submissions Temporarily Unavailable via Availity Sept. 18-21

Enhanced portal functionality offers increased efficiency

Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials

Voluntary nationwide recall: Sodium Chloride (Baxter – August 2026)

Voluntary nationwide recall: Sodium Chloride (B. Braun – August 2026)

Voluntary nationwide recall: Dextrose (Baxter – August 2026)

Voluntary nationwide recall: Thyroid (Vitruvias – August 2026)

CME Webinar: Lifestyle Medicine in Practice: Evidence‑Based Strategies for Chronic Disease Care

Attention All Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Providers: DMEPOS Enrollment Moratorium Has Ended

Further Clarification of Certain Billing Procedures for Substance Use Treatment Services

Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials

Pharmacy Policies Available Online

2027 Change Notification Series: Sept. 10

5160-4-02.3 - Exception for certain services provided by residents. (Amend/Original File)

Supplement 26-06: State of New Mexico Handicapping Labio-lingual Deviation (NM HLD) Index Report Form – MAD 908

Summer Provider Newsletter

Claims Work Queue Inpatient Hospitals

Provider Letter 2026-15: Re: Provider Contract Processing Update

New Limitation for Application of Caries Arresting Medicament for Texas Medicaid

OASIS for Administrators Trainings Set for September

System Maintenance Outage Scheduled for September 12–13, 2026

Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials

Watch for Digital Access to Medicare Advantage Prior Authorization Decision Letters via Availity® Essentials