All Insurance Policy Changes (Page 566)

Continuing from page 565. 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
April 2026
SelectHealth·Effective Apr 6, 2026
Select Health implemented multiple policy updates in March 2026 affecting surgical procedures, coding requirements, and coverage criteria. Key changes include modified transplant coverage requirements, expanded varicose vein procedure coverage, and a new coding editing system launching April 6, 2026 that will enforce stricter CMS compliance.
High impact
May 2026
SelectHealth·Effective Jun 1, 2026
Select Health updated multiple medical policies including new coverage exclusions, revised genetic testing criteria, and announced 25 new genetic testing policies effective June 1, 2026. Key changes include excluding low-dose radiation therapy for arthritis, modifying various procedure criteria, and emphasizing that genetic testing requires preauthorization to avoid claim denials.
High impact
June 2026
SelectHealth·Effective Jun 1, 2026
Select Health published 6 policy changes including 2 new policies and 4 revisions. Major changes include discontinuation of Spravato coverage for commercial plans, new hyoid suspension coverage criteria for sleep apnea, and removal of cystoscopy requirements for sacral nerve stimulation. Additionally, 25 new genetic testing policies are being incorporated.
Low impact
20-070 2020 Educational Webinars
Health Net·Identified Jun 20, 2026
Health Net is offering educational webinars throughout 2020 for healthcare providers with continuing education credits. Topics include cardiovascular health, vaccination strategies, HEDIS quality measures, and opioid management.
Low impact
20-071 2020 Educational Webinar
Health Net·Identified Jun 20, 2026
Health Net is offering free educational webinars throughout 2020 for healthcare providers and staff, covering topics like cardiovascular health, vaccination strategies, and HEDIS quality measures. Providers can earn continuing education credits by attending these monthly sessions.
Low impact
20-072 2020 Educational Webinars
Health Net·Identified Jun 20, 2026
Health Net is offering educational webinars throughout 2020 for healthcare providers in Fresno, Kings and Madera counties. These webinars provide continuing education credits and cover topics related to quality measures and patient care improvement.
Medium impact
20-020 Change to Capitated Claims Encounter Duplicate Logic
Health Net·Effective Nov 25, 2019
Health Net changed duplicate claim detection logic for Medi-Cal capitated encounters to include NDC codes. Claims with the same procedure code and NDC code combination will now be rejected as duplicates, whereas previously only procedure codes were checked.
Medium impact
20-021 Change to Capiatated Claims Encounter Duplicate Logic
Health Net·Effective Nov 25, 2019
Effective November 25, 2019, CalViva Health's duplicate claims detection system now includes NDC codes as part of the validation criteria for capitated encounter claims. If the same procedure code and NDC code combination is submitted more than once for the same member, the encounter will be rejected.
High impact
20-040 Submit Contract Status Validation for Hospital Directed Payment Programs
Health Net·Identified Jun 20, 2026
Health Net requires hospitals and capitated providers in 9 California counties to validate contract status for Medi-Cal encounters from July-December 2018 as part of hospital directed payment programs. Providers must complete specific file formats and return them by strict deadlines to receive supplemental reimbursement.
High impact
20-041 Submit Contract Status Validation for Hospital Directed Payment Programs
Health Net·Identified Jun 20, 2026
Health Net requires participating hospitals and physician groups in Fresno, Kings, and Madera counties to validate their contract status for Medi-Cal members by completing and returning specific encounter files. This validation is required for the Designated Public Hospital Enhanced Payment Program and Private Hospital Direct Payment Program supplemental reimbursements.
Medium impact
20-034 A More Centralized and Collaborative Approach to Delegation Oversight
Health Net·Effective Jan 1, 2020
Health Net is implementing a new Delegation Oversight Interactive Tool (DOIT) in 2020 that will centralize all utilization management reporting, audit activities, and corrective action tracking for participating physician groups. Delegated entities will need to transition to this new system for all UM-related submissions and communications.
Medium impact
20-035 A More Centralized and Collaborative Approach to Delegation Oversight
Health Net·Effective Jan 1, 2020
Health Net is implementing a new Delegation Oversight Interactive Tool (DOIT) in 2020 for Participating Physician Groups to centralize all utilization management reporting, audit activities, and corrective action tracking. This affects administrative processes for prior authorization and delegation oversight rather than direct billing procedures.
Medium impact
20-022 Rescheduled Appointments Must Meet Timely Access Standards
Health Net·Identified Jun 20, 2026
Health Net/CalViva Health requires rescheduled appointments to meet the same timely access standards as initial appointments for Medi-Cal members in Fresno, Kings, and Madera counties. Urgent appointments must be rescheduled within 48-96 hours and non-urgent within 10-15 business days depending on appointment type.
Medium impact
20-024 Rescheduled Appointments Must Meet Timely Access Standards
Health Net·Identified Jun 20, 2026
Health Net now requires that rescheduled appointments must meet the same timely access standards as initial appointments, with specific timeframes ranging from 48 hours for urgent PCP visits to 30 business days for well-woman visits. Health Net will monitor appointment scheduling quarterly and provide education to providers who fail to meet these standards.
Medium impact
20-025 Rescheduled Appointments Must Meet Timely Access Standards
Health Net·Identified Jun 20, 2026
Health Net now monitors rescheduled appointments quarterly to ensure they meet timely access standards as required by California regulations. Providers must reschedule appointments within specific timeframes (urgent within 48-96 hours, non-urgent within 10-15 business days) or face potential education interventions based on access to care grievance data.
Low impact
20-001 Be Aware of Opioid Potentiator Medications
Health Net·Identified Jun 20, 2026
Health Net issued guidance alerting providers about medications that enhance opioid effects and increase risks of respiratory depression, coma, and death. This is educational information to help prevent opioid misuse, not a billing or coverage change.
Low impact
20-003 Be Aware of Opioid Potentiator Medications
Health Net·Identified Jun 20, 2026
Health Net issued an educational policy alerting providers about medications that enhance opioid effects and increase risks of respiratory depression, coma, and death. This is informational guidance to help prevent opioid misuse, not a billing or coverage change.
Medium impact
20-002 Be Aware of Opioid Potentiator Medications
Health Net·Identified Jun 20, 2026
Health Net and CalViva Health issued guidance for Medi-Cal providers in Fresno, Kings and Madera counties about opioid potentiator medications that enhance opioid effects and increase risks of respiratory depression, coma and death. This is educational guidance to help providers assess drug interactions when prescribing opioids with other medications like benzodiazepines, antihistamines, muscle relaxants, and certain antibiotics.
Medium impact
20-066 DHCS Audit Notification
Health Net·Effective Feb 3, 2020
The Department of Health Care Services (DHCS) is conducting an onsite audit of CalViva Health and may visit provider sites from February 3-14, 2020. Providers must cooperate with DHCS staff if selected for an audit visit covering the period from February 1, 2019 through January 31, 2020.
Low impact
20-029 Medicare Diabetes Prevention Program (MDPP)
Health Net·Identified Jun 20, 2026
Health Net has partnered with Solera Health to offer the Medicare Diabetes Prevention Program (MDPP) for eligible Medicare Part B patients at risk for type 2 diabetes. Healthcare providers should encourage qualifying patients to take a one-minute eligibility quiz at www.solera4me.com/healthnet to access this no-cost preventive service program.
Low impact
20-030 Medicare Diabetes Prevention Program (MDPP)
Health Net·Identified Jun 20, 2026
Health Net has partnered with Solera Health to offer the Medicare Diabetes Prevention Program (MDPP) for Medicare Part B patients at risk for type 2 diabetes. This is a preventive service program with specific eligibility criteria including blood test values and BMI requirements.
Medium impact
20-094 Required Advance Notice of Terminating Providers or Change in Practice Locations
Health Net·Identified Jun 20, 2026
Health Net now requires 60 days advance notice for all provider terminations and practice location changes for Medi-Cal managed care plans. Terminations become effective on the first of the month approximately 60 days after Health Net receives the notice.
High impact
20-096 St. Vincent Medical Center and St. Vincent Dialysis Center Closure and Contract Termination
Health Net·Effective Feb 8, 2020
St. Vincent Medical Center and St. Vincent Dialysis Center are permanently closing (February 8, 2020 and January 30, 2020 respectively) and their Health Net contracts are terminating. Providers must immediately stop referring Health Net members to these facilities and redirect to participating Health Net providers.
High impact
20-097 St. Vincent Medical Center and St. Vincent Dialysis Center Closure and Contract Termination
Health Net·Effective Feb 8, 2020
St. Vincent Medical Center and St. Vincent Dialysis Center are permanently closing (February 8, 2020 and January 30, 2020 respectively), with Health Net contract termination effective immediately. All Health Net Cal MediConnect Plan enrollees must be referred to participating Health Net providers instead of these closed facilities.
Medium impact
20-088 Prior Authorization Requirements
Health Net·Effective Apr 1, 2020
Health Net has implemented new prior authorization requirements for continuous glucose monitoring, specific outpatient pharmaceuticals (Aliqopa, Azedra, Beouvu, Besponsa, Folotyn, Kanuma, Lutathera, Polivy, Remodulin), and H. pylori antibody testing. Transplant procedures now require use of Health Net's designated specialty network instead of HLA typing authorization.

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Archive by year

2023 2024 2025 2026

April 2026

May 2026

June 2026

20-070 2020 Educational Webinars

20-071 2020 Educational Webinar

20-072 2020 Educational Webinars

20-020 Change to Capitated Claims Encounter Duplicate Logic

20-021 Change to Capiatated Claims Encounter Duplicate Logic

20-040 Submit Contract Status Validation for Hospital Directed Payment Programs

20-041 Submit Contract Status Validation for Hospital Directed Payment Programs

20-034 A More Centralized and Collaborative Approach to Delegation Oversight

20-035 A More Centralized and Collaborative Approach to Delegation Oversight

20-022 Rescheduled Appointments Must Meet Timely Access Standards

20-024 Rescheduled Appointments Must Meet Timely Access Standards

20-025 Rescheduled Appointments Must Meet Timely Access Standards

20-001 Be Aware of Opioid Potentiator Medications

20-003 Be Aware of Opioid Potentiator Medications

20-002 Be Aware of Opioid Potentiator Medications

20-066 DHCS Audit Notification

20-029 Medicare Diabetes Prevention Program (MDPP)

20-030 Medicare Diabetes Prevention Program (MDPP)

20-094 Required Advance Notice of Terminating Providers or Change in Practice Locations

20-096 St. Vincent Medical Center and St. Vincent Dialysis Center Closure and Contract Termination

20-097 St. Vincent Medical Center and St. Vincent Dialysis Center Closure and Contract Termination

20-088 Prior Authorization Requirements