All Insurance Policy Changes (Page 92)

Continuing from page 91. 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
26-806 Medi-Cal Provider Operations Manual Updated: Review Changes for 2026
Health Net·Identified Jun 23, 2026
Health Net has updated their 2026 Medi-Cal Provider Operations Manual with changes to multiple sections including prior authorizations, compliance requirements, and operational procedures. All Medi-Cal providers must review the updated manual to ensure continued compliance with current contract requirements.
High impact
26-808 Medi-Cal Provider Operations Manual Updated: Review Changes for 2026
Health Net·Identified Jun 23, 2026
Health Net updated the Medi-Cal Provider Operations Manual for 2026 with changes across multiple sections including Prior Authorizations, Benefits, Compliance, Medical Records, and Utilization Management. All Medi-Cal providers in Imperial County must review the updated manual to ensure continued compliance with current contract requirements.
High impact
26-807 Medi-Cal Provider Operations Manual Updated: Review Changes for 2026
Health Net·Identified Jun 23, 2026
Health Net CalViva Health has updated their Medi-Cal Provider Operations Manual for 2026 with comprehensive changes across multiple sections including Prior Authorizations, Benefits, Credentialing, and Utilization Management. All Medi-Cal providers in Fresno, Kings, and Madera counties must review the updated manual to ensure continued compliance with current contract requirements.
High impact
Provider News - June 2026 (Special Edition)
Security Health Plan·Effective Jul 1, 2026
Security Health Plan is partnering with CoverMyMeds to streamline pharmacy prior authorizations across all lines of business. Effective July 1, 2026, all pharmacy benefit prior authorization requests must be submitted online through CoverMyMeds.com instead of traditional fax or phone methods.
Medium impact
MA00.026z, Bundled Procedure Codes
Independence Blue Cross·Effective Apr 1, 2026
Policy MA00.026z addresses bundled procedure codes for Medicare Advantage plans. This policy update affects how certain procedures must be billed together rather than separately, which could impact claim processing and reimbursement rates.
Medium impact
00.01.52aa, Bundled Procedure Codes
Independence Blue Cross·Effective Apr 1, 2026
This policy update addresses bundled procedure codes for commercial insurance plans. The policy becomes effective April 1, 2026, indicating changes to how certain procedures should be billed together rather than separately.
High impact
Supplement 26-03: ICF/IID Claims – Recoupment of Claims with Identical Billing and Attending Providers NPIs
New Mexico Medicaid·Effective May 1, 2026
New Mexico Medicaid will begin monthly retrospective reviews of ICF/IID claims starting May 1, 2026 to identify claims where the billing provider NPI and attending provider NPI are identical. Claims with matching NPIs will be subject to recoupment as they violate federal Medicaid requirements that the attending provider must be an individual practitioner separate from the billing facility.
Medium impact
Supplement 26-04: Medical Assistance Division (MAD) 378, Long Term Care Medical Assessment Abstract, Level of Care (LOC) Provider Guidance
New Mexico Medicaid·Effective Jun 22, 2026
New Mexico Medicaid is clarifying requirements for Primary Care Providers to complete and sign the Long-Term Care Medical Assessment Abstract (MAD 378) for patients with intellectual and developmental disabilities seeking DD and Mi Via Waiver services. Delays in completing this form can delay access to waiver services and may result in termination of benefits for annual recertifications.
Medium impact
Adaptive transportation services policy updates effective July 1, 2026
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Minnesota Department of Human Services renamed 'Special transportation' to 'Adaptive transportation services' effective July 1, 2026, with new requirements that the child's IEP/IFSP must document the need for adaptive transportation. CMS no longer recognizes aides or Personal Care Assistants (PCAs) as vehicle adaptations, requiring removal of this from eligible provider documentation. Billing teams must update systems, forms, and documentation requirements to reflect these changes.
Low impact
Waiver and AC Resources and MN–ITS Training certificates for June 16-17 session sent
Minnesota Medicaid (MHCP)·Effective Jun 23, 2026
The Minnesota Department of Human Services has distributed completion certificates to providers who attended the June 16-17 Waiver and Alternative Care (AC) Resources and MN-ITS Training session. Certificates were sent to providers' MN-ITS mailboxes using the NPI they used for registration and should be accessible by end of business June 23, 2026.
Medium impact
Online payment processing fees effective July 1
Minnesota Medicaid (MHCP)·Effective Jul 1, 2026
Effective July 1, 2026, Minnesota Health Care Programs will charge processing fees for online payments: 2.15% for credit/debit card payments and a flat $1.00 fee per ACH transaction. Billing teams must communicate these fees to patients and update payment processing systems to transparently display fees before payment confirmation.
Low impact
Maternal Health Webinars: Earn Continuing Education Credit
BCBS Texas·Effective Jun 18, 2026
Blue Cross Blue Shield of Texas is offering free continuing education webinars on maternal health through Morehouse School of Medicine, providing 1.0 CME credit per course. Two courses are available on demand: Respectful Maternity Care and Non-Medical Drivers of Health in Perinatal Care, available through September 30, 2026.
Medium impact
Updated Provider Manual Now Available
Blue Cross Blue Shield of Wyoming·Effective Aug 1, 2026
BCBSWY has released an updated Provider Manual with policy changes and announced a new CarePath Site of Care program launching August 2026 for Total Knee surgeries. A provider webinar is scheduled for June 24, 2025 to cover implementation details for billing and prior authorization staff.
Medium impact
Claim payments could be delayed this week
Priority Health·Effective Jun 18, 2026
Priority Health is experiencing technical issues that may delay claim payments this week. Some providers will receive deposits today depending on their financial institution, while others may not see payments until Monday due to the Friday June 19th federal holiday.
Medium impact
Attention Provider Type 60 (School Health Services): Update on Funding for School Services
Nevada Medicaid·Effective Jul 1, 2024
Nevada Medicaid will fully fund school-based health services starting July 1, 2024, eliminating the need for local government matching funds through Intergovernmental Transfer (IGT). This change will allow school health services claims to process faster without pending for matching funds.
Medium impact
Attention All Providers Billing Dental Services: 5% Rate Increase Approved for Dental Services
Nevada Medicaid·Effective Jan 1, 2024
Nevada Medicaid approved a 5% rate increase for dental services effective January 1, 2024. Impacted claims will be automatically reprocessed at updated rates, with results appearing on future remittance advice.
Medium impact
Reminders for Billing Outpatient Drugs for 340B-Covered Entities
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid is reminding providers of existing billing requirements for 340B drug program claims that have been in effect since July 1, 2022. Providers must use specific modifiers on physician-administered drug claims and specific codes on pharmacy point-of-sale claims when drugs are acquired through the 340B discount program.
Low impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for July 2024
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid announced multiple provider training sessions scheduled for July 2024, covering topics like claim appeals, secondary claims, substance use treatment, and specialty provider workshops. These are educational opportunities for providers and staff to improve their Nevada Medicaid billing and administrative processes.
Medium impact
Physician-Administered Drug (PAD) Claims Denied With Error 909 Have Been Reprocessed
Nevada Medicaid·Effective Jun 14, 2024
Nevada Medicaid has automatically reprocessed Physician-Administered Drug (PAD) claims from July 30 and August 10, 2023 that were previously denied with error code 909 (No response from PBM). Results appear on remittance advice dated June 14 or June 21, 2024, though reprocessed claims may still result in denials or no additional payment.
Medium impact
Update to Nevada Fee-For-Service Medicaid and Nevada Check Up NCPDP D.0 Payer Specifications
Nevada Medicaid·Effective Jun 24, 2024
Nevada Medicaid now requires a Place of Service field (307-C7) for vaccine claims for patients 19 and older, with specific codes for pharmacy (01) versus off-site (99) administration. This does not apply to current COVID-19 vaccines.
Medium impact
Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): New Form for Recipient Attestation for Continuing Use of Speech Generating Device (SGD)/Augmentative Communication Device (ACD)
Nevada Medicaid·Effective May 1, 2024
Effective May 1, 2024, Nevada Medicaid requires Durable Medical Equipment providers (Type 33) to submit a new form FA-1E (Recipient Attestation for Continuing Use) when requesting prior authorization for ongoing Speech Generating Device (SGD) or Augmentative Communication Device (ACD) use. This form captures recipient compliance and confirms appropriate equipment utilization.
Medium impact
Attention Provider Type 11 (Inpatient Hospital) and Provider Type 13 (Inpatient Psychiatric Hospital): Administrative Days Policy
Nevada Medicaid·Effective Jun 25, 2024
Nevada Medicaid has issued updated guidance on administrative days billing for inpatient hospitals and psychiatric facilities. Administrative days are lower-reimbursed hospital days for patients who no longer need acute care but cannot be discharged due to lack of appropriate placement, requiring prior authorization and specific revenue codes.
Medium impact
Applied Behavioral Analysis Coverage in a Psychiatric Residential Treatment Facility/Residential Treatment Facility
Nevada Medicaid·Effective Jun 20, 2024
Nevada Medicaid has resolved billing system barriers that were preventing payment for ABA services provided in psychiatric residential treatment facilities (PRTF) and residential treatment facilities (RTC). The state has implemented immediate fixes to allow same-day billing for PRTF/RTC services and ABA services for children with autism spectrum disorder and related conditions.
Medium impact
Medicaid Management Information System Updated with NCCI Quarter 3 2024 Files
Nevada Medicaid·Effective Jul 1, 2024
Nevada Medicaid has updated their system with new National Correct Coding Initiative (NCCI) edits for Quarter 3 2024, which will affect how procedure code combinations are processed and validated. The system will now use updated Medically Unlikely Edits (MUE) and Procedure-to-Procedure (PTP) edits to prevent improper payments when incorrect code combinations are reported.
High impact
Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2024 Professional Claims
Nevada Medicaid·Effective Jun 28, 2024
Nevada Medicaid has published the top 10 claim denial reasons from May 2024 with specific resolution steps. This provides billing teams with actionable guidance to prevent common denial issues including prior authorization problems, eligibility verification errors, and coverage rule violations.

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Archive by year

2023 2024 2025 2026

26-806 Medi-Cal Provider Operations Manual Updated: Review Changes for 2026

26-808 Medi-Cal Provider Operations Manual Updated: Review Changes for 2026

26-807 Medi-Cal Provider Operations Manual Updated: Review Changes for 2026

Provider News - June 2026 (Special Edition)

MA00.026z, Bundled Procedure Codes

00.01.52aa, Bundled Procedure Codes

Supplement 26-03: ICF/IID Claims – Recoupment of Claims with Identical Billing and Attending Providers NPIs

Supplement 26-04: Medical Assistance Division (MAD) 378, Long Term Care Medical Assessment Abstract, Level of Care (LOC) Provider Guidance

Adaptive transportation services policy updates effective July 1, 2026

Waiver and AC Resources and MN–ITS Training certificates for June 16-17 session sent

Online payment processing fees effective July 1

Maternal Health Webinars: Earn Continuing Education Credit

Updated Provider Manual Now Available

Claim payments could be delayed this week

Attention Provider Type 60 (School Health Services): Update on Funding for School Services

Attention All Providers Billing Dental Services: 5% Rate Increase Approved for Dental Services

Reminders for Billing Outpatient Drugs for 340B-Covered Entities

Attention All Providers, Delegates and Staff: Upcoming Training Sessions for July 2024

Physician-Administered Drug (PAD) Claims Denied With Error 909 Have Been Reprocessed

Update to Nevada Fee-For-Service Medicaid and Nevada Check Up NCPDP D.0 Payer Specifications

Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): New Form for Recipient Attestation for Continuing Use of Speech Generating Device (SGD)/Augmentative Communication Device (ACD)

Attention Provider Type 11 (Inpatient Hospital) and Provider Type 13 (Inpatient Psychiatric Hospital): Administrative Days Policy

Applied Behavioral Analysis Coverage in a Psychiatric Residential Treatment Facility/Residential Treatment Facility

Medicaid Management Information System Updated with NCCI Quarter 3 2024 Files

Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2024 Professional Claims