All Insurance Policy Changes (Page 46)

Continuing from page 45. 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
[Ohio] Flu prevention starts with a trusted conversation
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield (Ohio) is launching a flu vaccination education and awareness initiative for the 2026 flu season across all plan types. This is an informational/educational policy encouraging providers to proactively discuss flu vaccination with members, particularly high-risk populations. No billing code changes, coverage modifications, or prior authorization requirements are introduced.
Medium impact
[Ohio] Medicaid 2027 work requirements: What care providers need to know
Anthem BCBS·Effective Jan 1, 2027
Effective January 1, 2027, Ohio Anthem Medicaid will enforce new federal work requirements for certain non-disabled adults ages 19-64 in the Medicaid expansion population. Members must report 80 hours per month of work, school attendance, community service, or combination activities to maintain eligibility. Anthem will verify eligibility through data sources when possible, but some members will need to complete manual verification processes. Care providers should remind patients to keep contact information current to receive notices.
High impact
[Ohio] NDC edits for Medicare Advantage claims
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield is implementing National Drug Code (NDC) validation edits for Medicare Advantage claims 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 not greater than 0 or exceed 9,999,999.999. Billing teams must audit and correct NDC formatting in their systems immediately to prevent claim denials.
Medium impact
[Ohio] 2026 MyCare Ohio General and LTSS Provider Orientations
Anthem BCBS·Effective Aug 1, 2026
Anthem MyCare Ohio is offering mandatory provider orientation sessions for the Next Generation MyCare Ohio program, with separate sessions for general providers, LTSS agency providers, and LTSS independent providers. Sessions are scheduled from August through November 2026, and providers must attend the appropriate orientation based on their provider type listed in the Provider Network Management (PNM) System.
Low impact
[Ohio] You are invited: HEDIS®, documentation, and coding education
Anthem BCBS·Identified Aug 3, 2026
Anthem Blue Cross and Blue Shield Ohio Medicaid is offering free continuing education webinars for providers, coders, billers, and office staff on HEDIS quality measures, documentation standards, E/M coding, medical necessity, preventive care, and maternity services. This is an invitation to educational opportunities rather than a policy change affecting billing or coverage.
High impact
[Ohio] Getting VFC claims right: billing and reporting reminders
Anthem BCBS·Effective Aug 1, 2026
Anthem Ohio Medicaid/MyCare Ohio will reimburse the administration fee for VFC vaccines for eligible members under 19, but NOT the vaccine serum (provided free). Claims must include both serum code(s) AND administration code(s) with appropriate modifiers for HEDIS reporting compliance. Claims missing required codes will be denied.
Low impact
[Ohio] 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 (Ohio) is promoting vaginal estrogen therapy as an evidence-based treatment option for peri- and postmenopausal women with recurrent UTIs, aligned with American Urological Association guidelines. This is an educational bulletin encouraging provider awareness and patient counseling; no new billing codes, coverage restrictions, or prior authorization requirements are introduced.
High impact
[Ohio] NDC edits for Medicare Advantage claims
Anthem BCBS·Effective Aug 1, 2026
Effective August 1, 2026, Anthem Blue Cross and Blue Shield (MyCare Ohio) is implementing NDC validation edits for Medicare Advantage claims to align with CMS encounter requirements. Claims will be rejected if the NDC is not exactly 11 numeric digits, contains disallowed values (99999999999, 99999999992-996), or if the NDC unit count is ≤0 or exceeds 9,999,999.999. Billing teams must audit and correct NDC formatting in their systems immediately to prevent claim denials.
Medium impact
[Ohio] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·Effective Aug 1, 2026
Anthem Ohio has established new access-to-care standards for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners effective August 1, 2026. The policy mandates specific appointment availability timeframes (ranging from 24 hours for urgent care to 30 calendar days for routine visits), requires 24/7 after-hours coverage, and monitors compliance through vendor surveys, member grievances, and satisfaction data. Practices must ensure telehealth services are updated in provider directories by July 1, 2028.
High impact
[Ohio] Take action: Use no-cost electronic claims to avoid paper administrative fees
Anthem BCBS·Effective Oct 1, 2026
Anthem Blue Cross and Blue Shield is implementing a $5 administrative fee for paper-submitted claims and printed checks effective October 1, 2026 (Medicare Advantage) and November 1, 2026 (Commercial). The fee applies when net paid amounts are $10 or greater. Billing teams must transition to electronic claim submission via Availity to avoid these fees.
High impact
[Georgia] Medical Policy and Clinical Guideline updates
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross Blue Shield (Georgia) has adopted new and/or revised Medical Policies and Clinical Guidelines effective August 1, 2026. Some policies expand medical necessity criteria while others may reclassify previously covered services as not medically necessary or investigational. The update includes NOC (Not Otherwise Classified) codes to streamline medical review determinations. The specific policy details are contained in a separate PDF document that must be reviewed to identify affected procedures and billing codes.
High impact
[Georgia] Precertification list change notification
Anthem BCBS·Effective Apr 15, 2026
Anthem Blue Cross and Blue Shield in Georgia is adding seven new services to its precertification (prior authorization) requirements, effective on two dates: April 15, 2026 (two surgical procedures) and November 1, 2026 (five additional services including gene therapies, DME, and administrative requirements). Billing teams must obtain precertification before rendering these services or face claim reimbursement complications.
High impact
[Georgia] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, Anthem is implementing new reimbursement guidance for laboratory service modifiers 90, 91, and 92. Modifier 90 (pass-through laboratory billing) will no longer be reimbursed—the performing provider must bill directly. Modifiers 91 and 92 guidance remains unchanged but is being consolidated into a single policy. Billing teams must immediately audit claims and update systems to prevent denials for modifier 90 usage.
High impact
[Georgia] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, Anthem Blue Cross and Blue Shield is changing how unattended and home sleep studies must be billed. These services must now be billed as professional services on CMS-1500 forms only—they are no longer eligible for reimbursement when billed on UB-04 facility claim forms. Billing teams must ensure sleep study claims are submitted on the correct form type or face denial.
High impact
[Georgia] Site of Care Program for surgical procedures expansion
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, Anthem Blue Cross Blue Shield (Georgia) is expanding its Site of Care Program to require prior authorization review for surgical procedures performed at outpatient hospital settings, in addition to existing medical necessity reviews. The policy encourages procedures to be performed in ambulatory surgical centers (ASCs) or outpatient facilities when clinically appropriate to reduce member costs and improve efficiency.
High impact
[Georgia] Access surveys for primary care practitioners, specialty care practitioners, and behavioral health practitioners
Anthem BCBS·Effective Aug 1, 2026
Anthem Georgia has implemented new access standards and monitoring requirements for primary care, specialty care (OB/GYN and oncology), and behavioral health practitioners, effective August 1, 2026. The policy establishes specific appointment timeframes (e.g., preventive care within 60 days, urgent care within 24 hours) and requires 24/7 after-hours coverage. Practices will be monitored via surveys, member grievances, and satisfaction analysis, with compliance documentation required for any failures to meet standards.
Low impact
[Georgia] Your next coding tip could be one click away
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield (Georgia) is announcing the availability of interactive e-learning courses through their Learning Hub to support provider education on billing and coding. This is an informational resource announcement with expanded training offerings throughout 2026, not a change to billing, coding, coverage, or reimbursement policies.
Low impact
[Georgia] Flu prevention starts with a trusted conversation
Anthem BCBS·Identified Aug 3, 2026
Anthem Blue Cross and Blue Shield (Georgia) has issued an educational provider bulletin encouraging proactive flu vaccination conversations with members, particularly high-risk populations, for the 2026 flu season. This is an informational/training initiative with supporting resources and a CME webinar, not a billing or coverage policy change.
High impact
[Georgia] NDC edits for Medicare Advantage claims
Anthem BCBS·Effective Aug 1, 2026
Anthem Blue Cross and Blue Shield (Georgia) is implementing NDC 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 in all pharmacy claims submitted to this plan.
Low impact
[Georgia] 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 (Georgia) has released an educational 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 awareness and patient counseling, not a billing or coverage change.
High impact
[Georgia] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees
Anthem BCBS·Effective Oct 1, 2026
Anthem Blue Cross and Blue Shield (Georgia) is implementing a $5 administrative fee for each paper-submitted claim and printed paper check, effective October 1, 2026 for Medicare Advantage and November 1, 2026 for Commercial plans. Providers must submit claims electronically and enroll in EFT or another electronic payment option to avoid these fees. The fee applies when claim net paid amount or check total is $10 or greater.
Medium impact
[Georgia] ComplexCare Solutions SOAP note incentive program ending
Anthem BCBS·Effective Aug 31, 2026
Anthem Blue Cross and Blue Shield's Commercial Risk Adjustment SOAP Note Incentive Program, administered by ComplexCare Solutions, will end on August 31, 2026. Providers will no longer receive incentive payments for SOAP notes submitted after this date. SOAP notes received on or before August 31, 2026, will be processed and paid according to current methodology; no action is required from providers regarding member care.
Medium impact
[Ohio] ComplexCare Solutions SOAP note incentive program ending
Anthem BCBS·Effective Aug 31, 2026
Anthem Blue Cross and Blue Shield's Commercial Risk Adjustment SOAP Note Incentive Program, managed by ComplexCare Solutions (CCS), will end on August 31, 2026. Providers completing electronic health assessments on the Converged Patient Assessment portal will no longer receive incentive payments after this date. All qualifying SOAP notes submitted on or before August 31, 2026, will be processed and paid according to existing methodology.
High impact
[Georgia] Observation service billing: review CMS requirements before
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, Anthem Blue Cross and Blue Shield (Georgia) is updating observation service billing requirements to align with CMS guidance for claims billed under POS codes 19, 22, or 23. Key restrictions include: only one initial observation service code per patient visit, one observation code per calendar date per billing practitioner, and only the ordering/overseeing physician may bill observation codes—other practitioners must use appropriate outpatient service codes instead.
High impact
[Ohio] Observation service billing: review CMS requirements before
Anthem BCBS·Effective Sep 1, 2026
Effective September 1, 2026, Anthem Blue Cross and Blue Shield in Ohio is updating observation service billing requirements to align with CMS guidance for claims billed under POS codes 19, 22, or 23. Key changes include: only one initial observation service code per patient visit, only one observation code per calendar date per billing practitioner, and only the ordering/overseeing physician may bill observation codes—other practitioners must bill appropriate outpatient service codes instead.

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[Ohio] Flu prevention starts with a trusted conversation

[Ohio] Medicaid 2027 work requirements: What care providers need to know

[Ohio] NDC edits for Medicare Advantage claims

[Ohio] 2026 MyCare Ohio General and LTSS Provider Orientations

[Ohio] You are invited: HEDIS®, documentation, and coding education

[Ohio] Getting VFC claims right: billing and reporting reminders

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

[Ohio] NDC edits for Medicare Advantage claims

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

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

[Georgia] Medical Policy and Clinical Guideline updates

[Georgia] Precertification list change notification

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

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

[Georgia] Site of Care Program for surgical procedures expansion

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

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

[Georgia] Flu prevention starts with a trusted conversation

[Georgia] NDC edits for Medicare Advantage claims

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

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

[Georgia] ComplexCare Solutions SOAP note incentive program ending

[Ohio] ComplexCare Solutions SOAP note incentive program ending

[Georgia] Observation service billing: review CMS requirements before

[Ohio] Observation service billing: review CMS requirements before