All Insurance Policy Changes (Page 7)

Continuing from page 6. 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
26-886 Integrate "One Small Thing" Into Postpartum Visits Today
Health Net·Identified Jul 28, 2026
HealthNet California is promoting a brief clinical intervention called 'One Small Thing' to be integrated into postpartum visits to strengthen patient support and improve follow-up care. This is an educational initiative for providers to enhance postpartum care quality, not a billing or coverage change.
Medium impact
26-885 Integrate "One Small Thing" Into Postpartum Visits Today
Health Net·Identified Jul 28, 2026
Health Net California is launching a brief clinical intervention called 'One Small Thing' to be integrated into postpartum visits across Fresno, Kings, and Madera counties. This 1-2 minute intervention is designed to strengthen patient support and improve follow-up care during postpartum visits. While no specific billing code changes are mandated, providers should be aware this represents a new care delivery expectation for postpartum encounters.
Low impact
26-907m Improve Patient Safety with No-Cost Quality Resources
Health Net·Identified Jul 28, 2026
This is an informational policy directing hospitals to utilize no-cost quality improvement resources and benchmarking tools from HSAG, HQI, and Leapfrog to improve patient safety outcomes in HAIs, sepsis care, readmissions, and SUD care. This policy does not impose new billing requirements, coverage changes, or coding modifications for the medical billing team.
Low impact
26-908m Improve Patient Safety with No-Cost Quality Resources
Health Net·Identified Jul 28, 2026
This is an informational policy encouraging hospitals to utilize no-cost quality improvement resources and benchmarking tools to enhance patient safety outcomes in key areas including HAIs, sepsis care, and readmissions. The policy does not impose new billing requirements, coverage changes, or documentation mandates for the billing team.
Low impact
26-909m Improve Patient Safety with No-Cost Quality Resources
Health Net·Identified Jul 28, 2026
This is an informational policy from Medi-Cal (California) encouraging hospitals to utilize no-cost quality improvement resources and benchmarking tools to enhance patient safety outcomes. The policy does not impose new billing requirements, coding changes, or coverage restrictions—it is purely advisory and promotional in nature.
Medium impact
26-941 Submit Medi-Cal Onboarding Training Attestations Online Beginning August 1, 2026
Health Net·Effective Aug 1, 2026
Effective August 1, 2026, Medi-Cal will no longer accept paper attestations for provider onboarding training. All new contracting physicians, practitioners, and other providers must complete required onboarding training and submit attestations exclusively through an online form accessible via the Health Net provider portal.
Medium impact
26-942 Submit Medi-Cal Onboarding Training Attestations Online Beginning August 1, 2026
Health Net·Effective Aug 1, 2026
Effective August 1, 2026, Medi-Cal will no longer accept paper attestations for new provider onboarding training. All new contracting physicians, practitioners, and other providers must complete required onboarding training and submit attestations through an online form to avoid contract activation delays. This applies to individual providers and Participating Physician Groups (PPGs) in Fresno, Kings, and Madera counties.
Medium impact
26-943 Submit Medi-Cal Onboarding Training Attestations Online Beginning August 1, 2026
Health Net·Effective Aug 1, 2026
Effective August 1, 2026, Medi-Cal will no longer accept paper attestations for new provider onboarding training. All new contracting physicians, practitioners, and other providers must complete required onboarding training and submit attestations through an online form to avoid delays in contract activation.
High impact
26-876sum Summary Update: Updates to Prior Authorization Requirements
Health Net·Effective Jul 1, 2026
Health Net California has updated prior authorization (PA) requirements effective July 1 – October 1, 2026, with specific code list changes across three implementation phases. Billing teams must review the complete policy document (26-876) to identify which billing codes now require PA or have been removed from PA requirements, then update systems and workflows accordingly for all affected Health Net plans.
High impact
26-875sum Summary Update: Updates to Prior Authorization Requirements
Health Net·Effective Jul 1, 2026
Community Health Plan of Imperial Valley (CHPIV) is updating prior authorization requirements for Medi-Cal beneficiaries in Imperial County with three separate effective dates: July 1, 2026, July 28, 2026, and October 1, 2026. Billing teams must review the complete policy document (26-875) to identify which specific services require new or modified prior authorization and implement changes by each effective date to avoid claim denials.
High impact
26-874sum Summary Update: Updates to Prior Authorization Requirements
Health Net·Effective Jul 1, 2026
CalViva Health (Medi-Cal) has updated prior authorization requirements effective July 1, October 1, and July 28, 2026, with code-level additions and removals. Billing teams must review the complete policy document (26-874) to identify which specific services now require or no longer require prior authorization and update submission workflows accordingly for Fresno, Kings, and Madera counties.
Medium impact
26-877 Updates to Prior Authorization Requirements
Health Net·Identified Jul 28, 2026
Failed to analyze policy change
High impact
Durable Medical Equipment (DME) and Devices, Standard and Non-Standard 1.01.00
Excellus BlueCross BlueShield·Effective Aug 21, 2025
Excellus BlueCross BlueShield has updated its DME and medical device coverage policy effective August 21, 2025. The policy establishes unified medical necessity criteria for standard DME and devices, clarifies repair and replacement eligibility requirements, and reinforces that duplicate equipment, cosmetic upgrades, and equipment damaged through neglect are not covered. Billing teams must ensure all DME and device claims meet specific criteria including physician documentation of compliance, warranty status, and functional impairment impact on activities of daily living.
High impact
BT2026121: IHCP announces rate changes for PRTF DCS placements
Indiana Medicaid (IHCP)·Effective Jul 1, 2026
Indiana Health Coverage Programs (IHCP) has increased DCS wraparound payment rates for psychiatric rehabilitation treatment facilities (PRTFs) effective July 1, 2026. Billing teams must immediately update all July 2026 and forward claims for DCS-placed youth to use the new rates; any July claims submitted with old rates must be corrected and resubmitted to Gainwell. The policy reinforces mandatory use of specific procedure-code-and-modifier combinations for DCS placements.
Medium impact
BT2026122: IHCP updates reimbursement methodology for CPT code 50549
Indiana Medicaid (IHCP)·Effective Jun 1, 2026
Effective June 1, 2026 (retroactive), IHCP changes CPT 50549 (kidney endoscopic procedure) reimbursement from manual review to automated ASC group H rate when billed with specific surgical revenue codes (036X, 049X, and 18 other qualifying codes). Claims with non-qualifying revenue codes continue to require manual pricing review.
Medium impact
BT2026123: IHCP is reinforcing documentation and behavior assessment for ABA therapy treatment plans
Indiana Medicaid (IHCP)·Effective Oct 1, 2026
IHCP is reinforcing documentation requirements for ABA therapy treatment plans by establishing a standardized transition policy for behavior assessment tools. The Behavior Assessment System for Children (BASC) is moving from BASC-3 PRQ to BASC-4. Both versions will be accepted until October 1, 2026, after which only BASC-4 will be accepted. Providers must update assessment documentation practices accordingly.
High impact
BT2026124: IHCP receives approval for an HCBS provider certification and enrollment moratorium
Indiana Medicaid (IHCP)·Effective Aug 1, 2026
Indiana Health Coverage Programs (IHCP) has implemented a statewide provider certification and enrollment moratorium for home- and community-based services (HCBS) under five 1915(c) waivers effective August 1, 2026. The moratorium freezes new provider enrollment and service expansion for 21 specific HCBS service types for an initial 6-month period. Existing providers cannot add services, change ownership, or expand service areas for affected services during this time. Providers may request limited exceptions for access concerns.
High impact
BT2026125: IHCP recognizes maternity procedure code changes, effective Jan. 1, 2027
Indiana Medicaid (IHCP)·Effective Jan 1, 2027
Effective January 1, 2027, the American Medical Association is replacing traditional global obstetrical bundles with separate CPT codes for distinct maternity services (prenatal care, labor management, labor/delivery, and postpartum care). IHCP will recognize these new codes, representing a shift from bundled to unbundled billing. Additional policy guidance from IHCP is forthcoming.
High impact
BT2026126: IHCP adds coverage for subcutaneous injection Selarsdi (Q9998) under the medical benefit
Indiana Medicaid (IHCP)·Effective Dec 13, 2025
Indiana Health Coverage Programs (IHCP) now covers subcutaneous injection Selarsdi (HCPCS code Q9998) under the medical benefit for both managed care and fee-for-service plans, effective retroactively from December 13, 2025. Prior authorization is required, and providers have limited windows to submit/resubmit retroactive claims (90 days for managed care, 180 days for FFS from the July 23, 2026 bulletin date).
High impact
Update to North Carolina Medicaid Due Process/Appeals Unit Fax Number for Claim Review
NC Medicaid - NCDHHS·Effective Jul 15, 2026
North Carolina Medicaid has updated the fax number for the Due Process/Appeals Unit, which handles claim payment and denial reviews. Providers must immediately begin using the new fax number 984-687-9569 (effective July 15, 2026) when requesting claim reviews to ensure timely receipt of appeals.
Low impact
Sixth Annual Virtual Statewide Standard Plan Quality Forum
NC Medicaid - NCDHHS·Identified Jul 28, 2026
NC Medicaid is hosting a virtual quality forum on October 14, 2026, for providers and staff to discuss quality initiatives focused on early screening, child health, and women's health topics. This is an informational/educational event with no direct impact on billing codes, coverage, or reimbursement processes.
Low impact
07-21-2026 Provider Bulletin Summary IM IE LA OC SAC SD
Molina Healthcare·Effective Aug 14, 2026
Molina Healthcare of California is implementing a bi-weekly Provider Bulletin distribution schedule (every other Tuesday) starting July 21, 2026, and launching a redesigned website on August 14, 2026. Additionally, updates to Availity portal capabilities, timely access standards, Medi-Cal Rx enrollment requirements, and provider dispute processes are now available. Providers must actively review bulletins online for compliance as summaries are not substitutes for full policy details.
High impact
[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health Services
CareSource·Effective Aug 24, 2026
Effective August 24, 2026, CareSource will enforce same-day billing limits for behavioral health services in Ohio. When SUD IOP/PHP group counseling (H0015, H0015TG) is billed on the same day as TBS group services (H2020, H2012), providers may bill up to one hour of additional group services without prior authorization. Any additional group services exceeding one hour on the same date of service require prior authorization, and both services require PA when limits are exceeded.
Low impact
AHCCCS Announces HCBS Needs Tool and ECR Community Forum
Arizona Medicaid - AHCCCS·Identified Jul 28, 2026
AHCCCS is hosting a community forum on July 24, 2026, to gather feedback on draft Home and Community-Based Settings (HCBS) Needs Tool and Extraordinary Care Review (ECR) policies. This is an informational announcement about upcoming rulemaking; no immediate policy changes or billing impacts are in effect yet.
Low impact
AHCCCS Invites Public Input on Medicaid Demonstration
Arizona Medicaid - AHCCCS·Identified Jul 28, 2026
AHCCCS is renewing Arizona's Section 1115 Medicaid Demonstration and inviting public stakeholder input on the renewal proposal. This is a planning/feedback phase for potential changes to Arizona's Medicaid delivery system, managed care programs, ALTCS, KidsCare, and other initiatives affecting 1.8 million members. No immediate billing changes are required at this time, but practices should monitor for subsequent policy updates following the public comment period.

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Archive by year

2023 2024 2025 2026

26-886 Integrate "One Small Thing" Into Postpartum Visits Today

26-885 Integrate "One Small Thing" Into Postpartum Visits Today

26-907m Improve Patient Safety with No-Cost Quality Resources

26-908m Improve Patient Safety with No-Cost Quality Resources

26-909m Improve Patient Safety with No-Cost Quality Resources

26-941 Submit Medi-Cal Onboarding Training Attestations Online Beginning August 1, 2026

26-942 Submit Medi-Cal Onboarding Training Attestations Online Beginning August 1, 2026

26-943 Submit Medi-Cal Onboarding Training Attestations Online Beginning August 1, 2026

26-876sum Summary Update: Updates to Prior Authorization Requirements

26-875sum Summary Update: Updates to Prior Authorization Requirements

26-874sum Summary Update: Updates to Prior Authorization Requirements

26-877 Updates to Prior Authorization Requirements

Durable Medical Equipment (DME) and Devices, Standard and Non-Standard 1.01.00

BT2026121: IHCP announces rate changes for PRTF DCS placements

BT2026122: IHCP updates reimbursement methodology for CPT code 50549

BT2026123: IHCP is reinforcing documentation and behavior assessment for ABA therapy treatment plans

BT2026124: IHCP receives approval for an HCBS provider certification and enrollment moratorium

BT2026125: IHCP recognizes maternity procedure code changes, effective Jan. 1, 2027

BT2026126: IHCP adds coverage for subcutaneous injection Selarsdi (Q9998) under the medical benefit

Update to North Carolina Medicaid Due Process/Appeals Unit Fax Number for Claim Review

Sixth Annual Virtual Statewide Standard Plan Quality Forum

07-21-2026 Provider Bulletin Summary IM IE LA OC SAC SD

[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health Services

AHCCCS Announces HCBS Needs Tool and ECR Community Forum

AHCCCS Invites Public Input on Medicaid Demonstration