All Insurance Policy Changes (Page 75)

Continuing from page 74. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
DSS Important Message - Connecticut Medical Assistance Program (CMAP) Initiates Preparations for the NCPDP Version F6 Transition Questions; Multi-Factor Authentication Mandated Enrollment on August 1, 2026; Security Question Updates Notifications
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2028
Connecticut's Medicaid program (CMAP) is preparing for an industry-wide transition from NCPDP Version D.0 to Version F6 pharmacy claims standards, scheduled for 2028. Pharmacy providers must begin preparations now by confirming vendor support, monitoring future bulletins, and assessing current workflows that depend on Version D.0 data fields and transaction standards.
Medium impact
July 22, 2026 More older adults could benefit from PACE The program helps people have more good days and live independently. Policymakers …
Kaiser Permanente·Identified Jul 23, 2026
Failed to analyze policy change
High impact
Medicare Annual Wellness Visits will remain covered once per calendar year
Priority Health·Identified Jul 23, 2026
Priority Health has corrected a June policy error. Medicare Annual Wellness Visits coverage remains at once per calendar year (not once every 12 months as erroneously stated). Billing teams must revert to the original annual coverage frequency for Medicare beneficiaries and reference the corrected policy #064.
High impact
[Georgia] July 2026 Pharmacy Policy Updates
CareSource·Effective Jul 1, 2026
CareSource Georgia Medicaid has revised five pharmacy-related policies effective July 1, 2026, covering medical benefit medications, off-label medical necessity, multi-source brand medical necessity, preferred/non-preferred medication medical necessity, and multi-ingredient compound policies. The document is a notification index only and does not contain specific policy details, changes, or billing impacts. Your team must access the full policy documents on CareSource.com to determine what changed and take appropriate action.
High impact
Advance Payment agreements and Recoupment- Restart Collections September 1, 2026
Illinois Medicaid - HFS·Effective Sep 1, 2026
Illinois HFS is restarting collections on advance payment agreements for long-term care (LTC) nursing facilities effective September 1, 2026. Providers must execute renegotiated advance payment agreements by August 15, 2026, committing to repay all outstanding balances over 12 months in equal monthly installments. Failure to sign the agreement or make required payments will trigger immediate recoupment of 25% of the outstanding balance monthly for four months, with HFS authorized to withhold FFS claims, supplemental payments, and direct MCO payments to recover amounts owed.
High impact
AHCCCS DFSM Claims Clues - July 2026
Arizona Medicaid - AHCCCS·Effective Jul 20, 2026
AHCCCS has issued July 2026 claims guidance clarifying FQHC/RHC reimbursement for case management (T1016), best practices for prior authorization timing, claim submission deadlines, correcting a system denial error (L243.1), and eliminating unnecessary service descriptions in behavioral health claims. Critical changes include guidance that claims must be submitted within 6 months even if prior authorization is pending, and providers must not include service descriptions when reporting participating provider details.
Medium impact
2026-07-23 - CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement
Medicare/CMS·Identified Jul 23, 2026
This MLN Connects newsletter (July 23, 2026) contains multiple policy updates affecting different provider types: nursing home survey processes now use risk-based approaches; clinical labs must report private payor data by July 31, 2026; ACOs must submit participant lists by August 5, 2026; PEPPER billing analysis tool is relaunching; and enteral nutrition claims show high improper payment rates (23.8%) requiring billing corrections.
Low impact
26-823 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance
Health Net·Identified Jul 23, 2026
HealthNet California is hosting a webinar to help providers meet timely access standards and improve member experience to strengthen survey performance. This is an informational policy announcement regarding access improvement initiatives rather than a billing or coding change.
Low impact
26-822 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance
Health Net·Identified Jul 23, 2026
Health Net California is hosting a webinar to help providers meet access requirements and timely access standards to improve member experience and survey performance. This is an informational notice about an educational webinar opportunity, not a policy change affecting billing operations.
Medium impact
26-821 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance
Health Net·Identified Jul 23, 2026
HealthNet California (Medi-Cal in Imperial County) is hosting a webinar to help providers meet access requirements and timely access standards, which may impact appointment scheduling, provider availability, and member experience metrics. This is an informational/educational initiative rather than a specific billing code or coverage change, but practices should be aware of strengthened access performance expectations.
Low impact
26-820 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance
Health Net·Identified Jul 23, 2026
HealthNet California (Medi-Cal) is hosting a webinar to help providers meet timely access standards and improve member experience in Fresno, Kings, and Madera counties. This is an informational notice about access improvement initiatives and survey performance, not a billing or coverage policy change.
High impact
MA08.045q, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
Independence Blue Cross·Effective Jul 1, 2026
MA08.045q is a new Medicare Advantage policy effective 07/01/2026 governing coverage and billing for Tocilizumab and related biosimilars administered via intravenous infusion and subcutaneous injection. The billing team must review the full policy text to identify specific prior authorization requirements, covered indications, dosing parameters, and applicable HCPCS codes for these biologic medications.
Medium impact
MA08.057d, Belimumab (Benlysta®) for Intravenous Use
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
High impact
MA11.098, Migraine Deactivation Surgery
Independence Blue Cross·Effective Jul 22, 2026
INSUFFICIENT DATA: The policy title and metadata indicate MA11.098 is a Medicare Advantage policy on Migraine Deactivation Surgery effective 07/22/2026, but the actual policy content details are not provided in the source material. The billing team cannot implement specific changes without access to the full policy text describing coverage criteria, billing codes, prior authorization requirements, or other operational guidance.
Medium impact
MA07.032a, Tumor Treating Fields
Independence Blue Cross·Effective Jul 22, 2026
Medicare Advantage policy MA07.032a regarding Tumor Treating Fields has been reissued effective 07/22/2026. The full policy details are not provided in the source material, so specific coverage changes, billing code impacts, and prior authorization requirements cannot be determined from this announcement alone. The billing team must access the complete policy document to identify actionable changes.
Medium impact
MA05.047p, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
Medium impact
MA07.028, Home-Based Sleep Studies
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
Medium impact
MA05.002f, Hospital Beds and Accessories
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
Medium impact
MA08.145a, Sutimlimab-jome (Enjaymo)
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
Medium impact
MA08.099b, Burosumab-twza (Crysvita®)
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
Medium impact
MA09.014b, Computer-Aided Detection (CAD) System for Use with Chest Radiographs
Independence Blue Cross·Effective Jul 22, 2026
Medicare Advantage policy MA09.014b regarding Computer-Aided Detection (CAD) systems for chest radiographs has been reissued effective 07/22/2026. The billing team must review this updated policy to ensure proper coverage determination, billing, and documentation requirements for CAD-assisted chest X-ray interpretations under MA plans.
Medium impact
08.00.85t, Tocilizumab and Related Biosimilars for Intravenous Infusion
Independence Blue Cross·Effective Jul 1, 2026
Policy 08.00.85t establishes coverage guidelines for Tocilizumab and related biosimilars administered intravenously for commercial plans, effective July 1, 2026. The billing team must review this policy to understand prior authorization requirements, covered indications, and applicable HCPCS codes for IV infusion administration to ensure compliant billing and claims processing.
Medium impact
08.00.99e, Belimumab (Benlysta®) for Intravenous Use
Independence Blue Cross·Effective Jul 22, 2026
Policy 08.00.99e for Belimumab (Benlysta®) intravenous use has been reissued as of July 22, 2026. This is a pharmacy policy update for a biologic immunosuppressant medication used primarily in systemic lupus erythematosus (SLE) treatment. The billing team must review the updated coverage criteria, prior authorization requirements, and any changes to reimbursement guidelines to ensure compliant claims processing.
Medium impact
11.05.07d, Surgical Correction of Strabismus
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change
Medium impact
07.13.11k, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Independence Blue Cross·Identified Jul 23, 2026
Failed to analyze policy change

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2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 75) | PolicyChanges.app

DSS Important Message - Connecticut Medical Assistance Program (CMAP) Initiates Preparations for the NCPDP Version F6 Transition Questions; Multi-Factor Authentication Mandated Enrollment on August 1, 2026; Security Question Updates Notifications

July 22, 2026 More older adults could benefit from PACE The program helps people have more good days and live independently. Policymakers …

Medicare Annual Wellness Visits will remain covered once per calendar year

[Georgia] July 2026 Pharmacy Policy Updates

Advance Payment agreements and Recoupment- Restart Collections September 1, 2026

AHCCCS DFSM Claims Clues - July 2026

2026-07-23 - CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement

26-823 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance

26-822 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance

26-821 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance

26-820 Improve Access, Meet Timely Access Standards and Strengthen Survey Performance

MA08.045q, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection

MA08.057d, Belimumab (Benlysta®) for Intravenous Use

MA11.098, Migraine Deactivation Surgery

MA07.032a, Tumor Treating Fields

MA05.047p, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults

MA07.028, Home-Based Sleep Studies

MA05.002f, Hospital Beds and Accessories

MA08.145a, Sutimlimab-jome (Enjaymo)

MA08.099b, Burosumab-twza (Crysvita®)

MA09.014b, Computer-Aided Detection (CAD) System for Use with Chest Radiographs

08.00.85t, Tocilizumab and Related Biosimilars for Intravenous Infusion

08.00.99e, Belimumab (Benlysta®) for Intravenous Use

11.05.07d, Surgical Correction of Strabismus

07.13.11k, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects