All Insurance Policy Changes (Page 43)

Continuing from page 42. 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
[California] Access to care: appointment availability standards, surveys, and our Language Assistance Program
Anthem BCBS·Effective Jul 1, 2026
Anthem Blue Cross (California) is conducting Provider Appointment Availability Surveys (PAAS) and After-Hours Surveys from July 1–December 31, 2026, to ensure compliance with state-mandated access-to-care standards. Providers must meet specific appointment timeframes (e.g., 10 business days for non-urgent PCP, 48 hours for urgent care) or face corrective action. The policy also emphasizes language assistance services and requires providers to schedule interpreters 3 business days in advance.
High impact
[California] NDC edits for Medicare Advantage claims
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross Medicare Advantage is implementing new NDC (National Drug Code) validation edits effective August 1, 2026, to align with CMS encounter requirements. Claims will be rejected if NDCs are not exactly 11 numeric digits, contain disallowed values (99999999999, 99999999992-99999999996), or if NDC unit counts are ≤0 or exceed 9,999,999.999. Billing teams must audit and correct NDC formatting in all Medicare Advantage pharmacy claims.
High impact
[California] Professional claims update: ensuring accurate inpatient POS reporting
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, Anthem Blue Cross (Medi-Cal) will enforce stricter claims editing to ensure all services billed for inpatients use Place of Service (POS) 21 (Inpatient Hospital) or higher, regardless of where the face-to-face encounter occurred. Claims submitted with incorrect POS codes will be rejected and require correction/resubmission before reimbursement.
High impact
[California] Outpatient facility coding updates to support accurate claims processing
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, Anthem Blue Cross (California) will enforce stricter outpatient facility coding validation requiring that claims billed with specific revenue codes (0278, 0636, 0760, 0761, 0762, 0769) must include matching HCPCS or CPT codes. Claims with mismatched revenue and procedure codes will be rejected and must be corrected and resubmitted before reimbursement is issued.
Low impact
[California] Enhancing care for peri- and postmenopausal women: addressing recurrent UTIs with vaginal estrogen therapy
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross (California Medicare Advantage) is promoting vaginal estrogen therapy as an evidence-based treatment option for peri- and postmenopausal women with recurrent UTIs, aligned with AUA guidelines. This is an educational provider bulletin encouraging providers to identify eligible patients and discuss this prevention strategy; no billing code changes, coverage restrictions, or prior authorization requirements are specified in this policy.
Medium impact
[California] Annual grievance and appeals attestation requirement
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross (California) now requires all in-network, participating care providers to annually attest that patients have access to member grievance and appeals forms and filing instructions on-site. Providers must complete a Consumer Grievance and Appeals Attestation Survey via Medallia to confirm compliance with DMHC and California Health and Safety Code regulations. Anthem will contact organizations that have not confirmed adherence.
Low impact
[California] Your next coding tip could be one click away
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross is announcing expanded educational resources and e-learning courses for billing and coding training available on their Learning Hub. This is an informational update about training opportunities, not a policy change affecting billing, coding, coverage, or reimbursement practices.
High impact
[California] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross California has implemented access standard requirements for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners, effective August 1, 2026. The policy establishes mandatory appointment availability timeframes (ranging from 24 hours to 30 days depending on visit type) and requires 24/7 after-hours coverage with live or recorded messaging. Practices must meet these standards or face compliance monitoring through surveys, grievance analysis, and member satisfaction assessments.
Low impact
[California] Flu prevention starts with a trusted conversation
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross (California) is launching a flu prevention educational initiative encouraging providers to have proactive vaccination conversations with members, particularly high-risk populations. This is an informational and resource support bulletin—not a billing or coverage policy change. No new billing codes, prior authorization requirements, or reimbursement changes are introduced.
High impact
[California] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, Anthem Blue Cross Medicare Advantage will impose a $5 administrative fee for each paper-submitted claim (if net paid amount ≥$10) and each printed paper check (if total paid amount ≥$10). Providers must submit claims electronically and enroll in EFT or other electronic payment methods to avoid these fees.
High impact
[New York] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates
Anthem BCBS·Effective Nov 15, 2026
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective November 15, 2026, with significant expansions to genetic/molecular testing coverage for multiple cancer types, new approved drugs (imlunestrant, niraparib, dordaviprone, tovorafenib), and standardized orthopedic surgery requirements (12-week conservative management). Key changes include expanded breast cancer molecular testing to earlier stages, new prostate/thyroid cancer testing criteria, and updated musculoskeletal surgery pre-operative requirements.
High impact
[New York] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility
Anthem BCBS·Effective Nov 1, 2026
Anthem is implementing new reimbursement guidance for laboratory service modifiers effective November 1, 2026. Modifier 90 (pass-through laboratory billing) is now NOT reimbursable—the performing provider/facility must bill directly. Modifiers 91 and 92 retain existing guidance with no changes, but modifier 92 is limited to only 6 specific codes.
High impact
[New York] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, Anthem is updating its sleep studies reimbursement policy to clarify that unattended and home sleep studies must be billed as professional services on CMS-1500 forms only. These services are NOT eligible for reimbursement when billed on UB-04 facility claim forms. This policy now applies to both professional and facility care providers in multiple states including New York.
High impact
[New York] Professional claims update: ensuring accurate inpatient POS reporting
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, Anthem New York Medicaid will enforce stricter claims editing to require that all services billed for inpatient individuals must use Place of Service (POS) 21 (Inpatient Hospital) or higher, regardless of where the encounter occurred. Claims submitted with inconsistent POS codes will be rejected and require correction and resubmission before reimbursement.
Low impact
[New York] Enhancing care for peri- and postmenopausal women: addressing recurrent UTIs with vaginal estrogen therapy
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield (Medicare Advantage) is issuing an education and training bulletin encouraging providers to identify peri- and postmenopausal women with recurrent UTIs and discuss vaginal estrogen therapy as a prevention strategy per AUA guidelines. This is an informational policy promoting clinical best practices, not a billing or coverage rule change.
Low impact
[New York] Flu prevention starts with a trusted conversation
Anthem BCBS·Effective Aug 1, 2026
This is an educational and awareness bulletin from Anthem regarding flu prevention strategies for the 2026 flu season. It encourages providers to have proactive conversations with members about flu vaccination, particularly high-risk populations, and provides resources including conversation guides, CDC information, and CME webinar access. No billing code changes, coverage modifications, or prior authorization requirements are introduced.
High impact
[New York] NDC edits for Medicare Advantage claims
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield is implementing NDC (National Drug Code) validation edits for Medicare Advantage claims effective August 1, 2026, to align with CMS encounter requirements. Claims will be rejected if the NDC is not exactly 11 numeric digits, contains disallowed values (99999999999, 99999999992-99999999996), or if the NDC unit count is not between 0 (exclusive) and 9,999,999.999. Billing teams must audit and correct NDC formatting in their systems to prevent claim denials.
Low impact
[New York] Your next coding tip could be one click away
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross Blue Shield is promoting expanded access to interactive e-learning courses for billing and coding education through an online library on on24.com. This is an informational announcement about available educational resources for coders and billers to improve accuracy and stay current with coding changes, with new courses being added throughout 2026.
High impact
[New York] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross New York has implemented new access-to-care standards for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners, effective August 1, 2026. Providers must meet specific appointment timeframes (24 hours for urgent care, 60 days for preventive care, 10 business days for routine visits) and maintain 24/7 after-hours coverage, with compliance monitored through surveys, member grievances, and satisfaction data.
High impact
[New York] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, Anthem Blue Cross will impose a $5 administrative fee for each paper-submitted claim (if net paid amount ≥ $10) and each printed paper check (if total paid amount ≥ $10) for contracted Medicare Advantage providers in New York. Providers must submit claims electronically and enroll in EFT or other electronic payment options to avoid these fees.
High impact
[Virginia] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates
Anthem BCBS·Effective Nov 15, 2026
Carelon (Anthem Medicare Advantage Virginia) updated clinical appropriateness guidelines effective November 15, 2026, expanding coverage for genetic/molecular testing in multiple cancer types (breast, prostate, lung, thyroid, etc.), hematologic malignancies, and orthopedic procedures. Key changes include new drug therapies triggering testing requirements (imlunestrant, niraparib), broadened indications for existing tests, and standardized 12-week conservative management requirements for joint surgery. Practices must update prior authorization criteria, clinical documentation templates, and testing protocols to align with expanded coverage.
Medium impact
[Virginia] Precertification list change notification
Anthem BCBS·Effective Apr 15, 2026
Anthem Blue Cross and Blue Shield Virginia is adding seven new services to its precertification (prior authorization) requirement list. Four services are effective immediately (4/15/2026), and three additional services become effective 11/1/2026. Failure to obtain precertification before rendering these services may result in claim denials and reimbursement complications.
Low impact
[Virginia] Enhancing care for peri- and postmenopausal women: addressing recurrent UTIs with vaginal estrogen therapy
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield (Virginia) issued an educational bulletin promoting vaginal estrogen therapy as a recommended treatment for recurrent UTIs in peri- and postmenopausal women, aligned with AUA clinical guidelines. This is an informational policy update to encourage provider awareness and patient counseling rather than a billing or coverage rule change.
High impact
[Virginia] NDC edits for Medicare Advantage claims
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield is implementing NDC (National Drug Code) validation edits for Medicare Advantage claims effective August 1, 2026, to align with CMS encounter requirements. Claims will be rejected if the NDC is not exactly 11 numeric digits, contains disallowed values (99999999999, 99999999992-99999999996), or if the NDC unit count is not greater than 0 or exceeds 9,999,999.999. Billing teams must audit and correct NDC formatting on all drug claims to prevent denials.
Low impact
[Virginia] Flu prevention starts with a trusted conversation
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield (Virginia) has issued an educational bulletin encouraging providers to lead proactive flu vaccination conversations with members, particularly high-risk populations, during the 2026 flu season. The policy provides resources, conversation guides, and information about HEDIS immunization measures but does not introduce new billing requirements, coverage changes, or prior authorization mandates.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 43) | PolicyChanges.app

[California] Access to care: appointment availability standards, surveys, and our Language Assistance Program

[California] NDC edits for Medicare Advantage claims

[California] Professional claims update: ensuring accurate inpatient POS reporting

[California] Outpatient facility coding updates to support accurate claims processing

[California] Enhancing care for peri- and postmenopausal women: addressing recurrent UTIs with vaginal estrogen therapy

[California] Annual grievance and appeals attestation requirement

[California] Your next coding tip could be one click away

[California] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners

[California] Flu prevention starts with a trusted conversation

[California] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees

[New York] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates

[New York] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility

[New York] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional

[New York] Professional claims update: ensuring accurate inpatient POS reporting

[New York] Enhancing care for peri- and postmenopausal women: addressing recurrent UTIs with vaginal estrogen therapy

[New York] Flu prevention starts with a trusted conversation

[New York] NDC edits for Medicare Advantage claims

[New York] Your next coding tip could be one click away

[New York] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners

[New York] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees

[Virginia] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates

[Virginia] Precertification list change notification

[Virginia] Enhancing care for peri- and postmenopausal women: addressing recurrent UTIs with vaginal estrogen therapy

[Virginia] NDC edits for Medicare Advantage claims

[Virginia] Flu prevention starts with a trusted conversation