All Insurance Policy Changes (Page 776)

Continuing from page 775. 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
5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (New/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Medicaid has updated Rule 5160-1-17.12 regarding qualified entity requirements and responsibilities for determining presumptive eligibility for Medicaid enrollment. This appears to be a procedural update that may affect how healthcare practices handle Medicaid eligibility determination processes.
Medium impact
Medicaid Alert - MA-1992-21
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has issued guidance regarding the use of Form MC-19 (9/91) for reporting and claiming EPSDT/HealthStart screening and related procedures. This affects pediatric preventive care billing and claim submission processes for Medicaid patients.
Low impact
5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (Rescind/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid is rescinding and simultaneously refiling Rule 5160-1-17.12 regarding qualified entity requirements for determining presumptive eligibility. This appears to be an administrative action to update the rule structure while maintaining similar requirements for entities that determine Medicaid presumptive eligibility.
Medium impact
5160-44-05 - Nursing facility-based level of care home and community-based services programs and specialized recovery services program: incident management. (New/Original File)
Ohio Medicaid·Effective Oct 6, 2024
Ohio Medicaid has updated Rule 5160-44-05 regarding incident management requirements for nursing facility-based level of care home and community-based services programs and specialized recovery services programs. This policy establishes new incident reporting and management procedures for Medicaid providers serving these populations.
Medium impact
Medicaid Alert - MA-1992-23
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid is reinstating recoupments, meaning they will resume recovering overpayments from providers. This likely affects providers who previously received overpayments that were temporarily suspended from collection.
Medium impact
Medicaid Alert - MA-1992-24
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid policy MA-1992-24 introduces changes to claim attachment requirements. Billing teams must review updated procedures for submitting supporting documentation with Medicaid claims to ensure proper processing and avoid denials.
Low impact
5160-44-05 - Nursing facility-based level of care home and community-based services programs, medicaid managed care organizations, the OhioRISE program, and specialized recovery services program: incident management. (Rescind/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid has updated Rule 5160-44-05 regarding incident management requirements for nursing facility-based level of care home and community-based services programs, Medicaid managed care organizations, and the OhioRISE program. This appears to be a rescission and replacement of existing incident reporting rules that will take effect on June 26, 2026.
Medium impact
Medicaid Alert - MA-1992-25
New Jersey Medicaid·Identified Jun 20, 2026
Failed to analyze policy change
Medium impact
Medicaid Alert - MA-1992-26
New Jersey Medicaid·Identified Jun 20, 2026
Unable to analyze policy MA-1992-26 as the actual policy content was not provided - only metadata including title, category, and source URL were available.
Medium impact
5160-26-14 - Medicaid managed care organizations: incident management. (New/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid has filed a new rule 5160-26-14 establishing incident management requirements for Medicaid managed care organizations. This is a new administrative rule that will define how managed care organizations must handle and report incidents.
Low impact
Newsletter Vol. 2, No. 37
New Jersey Medicaid·Identified Jun 20, 2026
Unable to analyze policy change due to insufficient content provided. Only document metadata (title, URL, age) was included without the actual policy text or substantive information about what changes are being implemented.
Medium impact
5160-59-09 - The OhioRISE program: incident management. (New/Original File)
Ohio Medicaid·Effective Jun 26, 2026
The Ohio Department of Medicaid has established a new rule (5160-59-09) for incident management within the OhioRISE program. This creates new administrative requirements for providers participating in Ohio's specialized Medicaid program for children and youth with complex behavioral health needs.
Medium impact
Newsletter Vol. 2, No. 38
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has established a procedure for healthcare providers to request payment for uncollected PAAD (Pharmaceutical Assistance to the Aged and Disabled) co-payment balances from patients. This affects pharmacy-related billing and may require additional documentation or claim submission processes.
Low impact
5160-15-10 - Transportation: non-emergency services through a CDJFS. (Amend/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid has filed an amendment to rule 5160-15-10 regarding non-emergency transportation services provided through County Departments of Job and Family Services (CDJFS). This appears to be an administrative update to existing transportation benefit regulations.
High impact
Newsletter Vol. 2, No. 39
New Jersey Medicaid·Effective Sep 1, 2024
Effective September 2024, all New Jersey Medicaid-enrolled facilities performing clinical laboratory testing must have a valid CLIA identification number on file. Reimbursement for laboratory services will not be processed without a CLIA ID, and reference laboratories must be enrolled as New Jersey Medicaid providers with valid CLIA certification.
Low impact
5160-15-01 - Transportation: definitions. (Amend/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Medicaid has filed an amendment to transportation definitions policy 5160-15-01 with an effective date of June 26, 2026. This is an administrative policy filing that updates definitions related to medical transportation services for Ohio Medicaid beneficiaries.
High impact
Newsletter Vol. 2, No. 40
New Jersey Medicaid·Effective Jul 1, 2024
New Jersey Medicaid requires State and County Governmental Psychiatric Facilities to recalculate occupancy levels effective July 2024 and submit monthly certification statements with all billing to the fiscal agent. Facilities with occupancy below a specified threshold will receive reimbursement based on inpatient psychiatric rates or statewide average nursing facility rates. Federal funding is contingent on timely monthly certification statement submission.
High impact
Newsletter Vol. 2, No. 41
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid requires all providers to submit hardcopy claims using ONLY the NJ version of the claim form, not the federal HCFA version. Claims submitted on the federal HCFA form will be rejected and returned to the provider for resubmission on the NJ form. This applies immediately to all Medicaid and Medicare-Medicaid crossover claims.
High impact
5160-1-17.51 - Suspension of medicaid provider claims payments during a pending audit or investigation. (New/Emergency)
Ohio Medicaid·Effective Jun 2, 2026
Ohio Department of Medicaid has implemented an emergency rule allowing suspension of Medicaid provider claims payments during pending audits or investigations. This temporary rule is effective immediately and expires October 1, 2026.
High impact
Newsletter Vol. 2, No. 42
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has updated the Independent Clinical Laboratory Services Manual with additional HCPCS procedure codes and revised Maximum Fee Allowance Schedule rates for laboratory and pathology services. Billing teams must immediately replace their current subchapter with the attached updated version to ensure accurate reimbursement for independent clinical laboratories.
Medium impact
5160-59-02 - OhioRISE: eligibility and enrollment. (Amend/Final File)
Ohio Medicaid·Effective Jul 1, 2026
Ohio Rule 5160-59-02 for OhioRISE eligibility and enrollment has been amended with an effective date of July 1, 2026. This rule governs eligibility criteria and enrollment processes for Ohio's specialized Medicaid program serving children and youth with complex behavioral health needs.
Medium impact
Newsletter Vol. 2, No. 43
New Jersey Medicaid·Effective Aug 1, 2024
New Jersey Medicaid is introducing HCPCS procedure code X for partial payment reconciliation of claims previously submitted to Prudential Insurance that were only partially paid. Providers must resubmit these claims to Paramax Unisys with the new code, complete documentation of the original claim and partial payment, and the total charge from the original submission. This interim procedure is effective immediately through October only.
Low impact
5160-13-08 - Dialysis center services: add-on payment for nursing facility-based hemodialysis furnished by a dialysis center. (New/Final File)
Ohio Medicaid·Effective Jul 1, 2026
Ohio Medicaid is implementing a new add-on payment for dialysis centers providing hemodialysis services to patients in nursing facilities. This creates a new reimbursement category for dialysis centers serving this specific patient population.
High impact
Newsletter Vol. 2, No. 44
New Jersey Medicaid·Effective Jan 1, 2024
Designated outstation hospitals must reimburse county welfare agencies for the nonfederal share of Medicaid eligibility determination costs. The Division will implement automated withholding of Medicaid payments at the beginning of each calendar quarter (one-fourth of estimated annual outstation charge), identified by county welfare agency numeric codes on the Remittance Advice.
Medium impact
Medicaid Alert - MA-1992-27
New Jersey Medicaid·Identified Jun 20, 2026
Failed to analyze policy change

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

5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (New/Original File)

Medicaid Alert - MA-1992-21

5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (Rescind/Original File)

5160-44-05 - Nursing facility-based level of care home and community-based services programs and specialized recovery services program: incident management. (New/Original File)

Medicaid Alert - MA-1992-23

Medicaid Alert - MA-1992-24

5160-44-05 - Nursing facility-based level of care home and community-based services programs, medicaid managed care organizations, the OhioRISE program, and specialized recovery services program: incident management. (Rescind/Original File)

Medicaid Alert - MA-1992-25

Medicaid Alert - MA-1992-26

5160-26-14 - Medicaid managed care organizations: incident management. (New/Original File)

Newsletter Vol. 2, No. 37

5160-59-09 - The OhioRISE program: incident management. (New/Original File)

Newsletter Vol. 2, No. 38

5160-15-10 - Transportation: non-emergency services through a CDJFS. (Amend/Original File)

Newsletter Vol. 2, No. 39

5160-15-01 - Transportation: definitions. (Amend/Original File)

Newsletter Vol. 2, No. 40

Newsletter Vol. 2, No. 41

5160-1-17.51 - Suspension of medicaid provider claims payments during a pending audit or investigation. (New/Emergency)

Newsletter Vol. 2, No. 42

5160-59-02 - OhioRISE: eligibility and enrollment. (Amend/Final File)

Newsletter Vol. 2, No. 43

5160-13-08 - Dialysis center services: add-on payment for nursing facility-based hemodialysis furnished by a dialysis center. (New/Final File)

Newsletter Vol. 2, No. 44

Medicaid Alert - MA-1992-27