All Insurance Policy Changes (Page 98)

Continuing from page 97. 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
BT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026
Indiana Medicaid (IHCP)·Identified Jul 15, 2026
Failed to analyze policy change
High impact
BT2026118: IHCP reminds ABA agencies of accreditation requirement
Indiana Medicaid (IHCP)·Effective Oct 1, 2027
IHCP requires all Applied Behavior Analysis (ABA) agencies to obtain accreditation from ACQ or BHCOE. Currently enrolled ABA providers must submit documentation of accreditation initiation by August 1, 2026, and must complete full accreditation by October 1, 2027, or their IHCP enrollment will be deactivated.
Medium impact
Opioid Antagonist Distribution Grant Information Session
Arizona Medicaid - AHCCCS·Identified Jul 15, 2026
Failed to analyze policy change
Low impact
AHCCCS Launches GenAI-Powered Provider Locator to Improve Access to Opioid Use Disorder Treatment Across Arizona
Arizona Medicaid - AHCCCS·Effective Jul 14, 2026
AHCCCS has launched a new GenAI-powered Opioid Use Disorder (OUD) Service Provider Locator tool to help patients find treatment services across Arizona. This is an informational tool for patient access to care and does not directly impact billing codes, prior authorization requirements, or reimbursement processes for healthcare providers.
Low impact
Building a better member experience through AI
Regence BlueCross BlueShield of Oregon·Identified Jul 15, 2026
Regence is implementing AI-powered tools to improve member experience and customer service efficiency, including a Customer Service Virtual Assistant (CVA) for internal use and a member-facing Regence Assistant for benefit questions. The policy emphasizes human oversight, privacy protection, and accuracy verification—this is primarily an operational/technology initiative rather than a billing or coverage change.
Medium impact
Provider News - May 2016
Security Health Plan·Identified Jul 15, 2026
Failed to analyze policy change
Medium impact
Provider News - January 2017
Security Health Plan·Effective Jan 1, 2017
Security Health Plan Medicare Advantage members now have access to routine eyeglasses stipends effective January 1, 2017, varying by plan ($150-$275). Providers must submit claims to Security Health Plan (not patient-paid claims) and choose one of three billing workflows to handle the stipend application and member balance collection.
High impact
Provider News - February 2017
Security Health Plan·Effective Feb 1, 2017
Security Health Plan requires decimal billing on time-based therapy codes (PT, OT, speech therapy) for BadgerCare Plus members when less than one full unit of service is provided. For example, 7.5 minutes of a 15-minute code should be billed as 0.5 units. The plan will audit therapy claims for accurate compliance with this requirement.
High impact
Provider News - March 2017
Security Health Plan·Effective Feb 1, 2017
Security Health Plan has released multiple new medical policies and updated existing ones effective January-February 2017, including 10 newly developed policies (Cryoablation, Gastric Pacing, Urinary Incontinence, Migraine/Cluster Headache management, and others) and updated criteria for existing procedures. Providers must obtain copies of these policies to ensure billing compliance, as payment requires meeting all outlined medical criteria. Prior authorization requirements for commercial plans remain in effect for office and outpatient-based procedures.
Medium impact
Provider News - May 2017
Security Health Plan·Effective Jun 1, 2017
Security Health Plan released its May 2017 Provider News containing three main items: (1) announcement of a new provider portal launching June 1, 2017 with enhanced prior authorization and eligibility verification features; (2) recognition of high-performing skilled nursing facilities; and (3) educational coding guidance on cerebrovascular accidents (CVA) for accurate ICD-10 CM coding. The provider portal transition requires practices to designate organization administrators and complete access requests before the June 1 launch.
High impact
Provider News - June 2017
Security Health Plan·Effective Nov 1, 2017
Security Health Plan is implementing new medical pharmacy management services through Magellan Rx effective November 1, 2017, requiring prior authorization for medical pharmaceuticals (drugs administered in medical settings). Additionally, colorectal cancer screening coverage policies are clarified across multiple plan types with specific frequency limits and alternative screening options promoted to improve member compliance.
Low impact
Provider News - August 2017
Security Health Plan·Identified Jul 15, 2026
This August 2017 Provider News from Security Health Plan is primarily informational, covering community opioid prevention initiatives, member health coaching success stories, fall prevention workshops, and updates to the provider portal. No direct billing code changes, coverage modifications, or reimbursement adjustments are announced. The portal updates include new FAQs regarding claims/eligibility permissions and prior authorization workflows.
High impact
Provider News - November 2017
Security Health Plan·Effective Nov 1, 2017
Security Health Plan implements multiple significant changes effective Nov 1 - Jan 1, 2018: (1) New prior authorization requirements for 2018 including cardiac valve replacement, femoro-acetabular surgery, MAZE procedures, and skin substitutes; (2) Pharmacy benefit manager transition from current provider to MedImpact effective Jan 1, 2018; (3) Magellan Rx prior authorization program for specific medications beginning Nov 1, 2017; (4) Updated Interqual 2017 clinical criteria for inpatient medical/behavioral health admissions effective Sept 1, 2017.
High impact
Provider News - December 2017
Security Health Plan·Effective Jan 1, 2018
Effective January 1, 2018, Security Health Plan requires all corrected claims to be clearly marked as corrected or they will be denied as duplicates. Additionally, the plan is launching a Dual-Eligible Special Needs Plan (D-SNP) coordinating Medicare Advantage and Wisconsin Medicaid for eligible members in specified counties, requiring providers to work closely with care coordination teams.
High impact
Provider News - February 2018
Security Health Plan·Effective Feb 1, 2018
Security Health Plan has implemented a provider portal alert system to identify Medicare Advantage members with Qualified Medicare Beneficiary (QMB) status or full dual eligibility (Medicare/Medicaid). Providers must stop billing these members for Medicare Part A/B coinsurance, copayments, and deductibles, as federal law prohibits such charges. Providers should verify current Medicaid eligibility with Wisconsin or through CMS HETS before billing.
Medium impact
Provider News - April 2018
Security Health Plan·Identified Jul 15, 2026
Failed to analyze policy change
High impact
Provider News - June 2018
Security Health Plan·Effective Oct 1, 2018
Security Health Plan's June 2018 Provider News contains three actionable updates: (1) a new Risk Adjustment Data Validation (RADV) audit requiring providers to submit medical records documentation for selected members on ACA plans; (2) removal of maternity admission notification requirements for stays within federal timeframes (48 hours vaginal, 96 hours cesarean); and (3) expanded prior authorization requirements for specialty drugs effective October 1, 2018, plus guidance on EHR documentation practices to avoid 'cloning' compliance issues.
Medium impact
MA00.033s, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Independence Blue Cross·Identified Jul 15, 2026
Failed to analyze policy change
High impact
00.10.01an, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Independence Blue Cross·Effective Apr 1, 2026
This policy defines which services provided by HMO and HMO-POS primary care providers are paid separately (above capitation) rather than being included in their monthly capitated payments. The billing team must identify which specific services trigger separate reimbursement versus those bundled under capitation to ensure correct claim submission and payment processing.
Low impact
Justice-Involved (JI) Reentry Initiative: Updates to JI Microlearning Titles
Medi-Cal·Effective Jul 13, 2026
Medi-Cal has updated the titles of three Justice-Involved (JI) Reentry Initiative microlearning videos effective July 13, 2026. Providers serving justice-involved populations must register for updated webinar sessions through the Medi-Cal Learning Portal (MLP) to access the renamed training content on pre-release screening services.
High impact
Medical and Clinical Policy Updates - Effective October 1, 2026
Sentara Health Plans·Effective Oct 1, 2026
Effective October 1, 2026, Sentara Health Plans is implementing multiple coverage and prior authorization changes across Virginia for Commercial, Medicaid, and Medicare products. Key changes include: new prior authorization requirements for common orthopedic procedures (knee/hip arthroplasty, ankle revision), home health nursing services with benefit restrictions, new non-covered services (personal care, habilitation waivers, certain vaccines), and specific oncology lab work requiring OncoHealth contact. Billing teams must immediately update systems to enforce these requirements to avoid claim denials.
Low impact
Upcoming Maintenance: Prior Authorization Tool
Blue Cross Blue Shield of Vermont·Identified Jul 14, 2026
This is a clarification/reissuance of Vermont's Uniform Medical Prior Authorization Form for non-urgent requests. The form standardizes how providers must submit prior authorization requests to health plans, requiring completion of all fields including patient demographics, clinical information, diagnosis codes, procedure/test codes, and supporting documentation. While the policy is dated 1 day old, the underlying form was issued by Vermont Department of Financial Regulation on 3/1/2014, suggesting this is a republication or reminder rather than a substantive new change.
Medium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, CPT code C1607 (Neurostimulator, integrated, rechargeable with all implantable and external components including charging system) now requires precertification/prior authorization through Carelon Medical Benefits Management for all Anthem Blue Cross Medicare Advantage PPO plans in California. Providers must submit authorization requests before delivering this service to avoid claim denials.
Medium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, CPT code C1607 (Neurostimulator, integrated rechargeable implant) will require precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in New York. Providers must submit authorization requests via Carelon's provider portal, Availity Essentials, or email before performing procedures with this code.
Medium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·Effective Nov 1, 2026
Effective November 1, 2026, CPT code C1607 (Neurostimulator, integrated rechargeable implantable) will require precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Ohio. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing these procedures.

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

Insurance Policy Changes Tracker: All Payer Updates (Page 98) | PolicyChanges.app

BT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026

BT2026118: IHCP reminds ABA agencies of accreditation requirement

Opioid Antagonist Distribution Grant Information Session

AHCCCS Launches GenAI-Powered Provider Locator to Improve Access to Opioid Use Disorder Treatment Across Arizona

Building a better member experience through AI

Provider News - May 2016

Provider News - January 2017

Provider News - February 2017

Provider News - March 2017

Provider News - May 2017

Provider News - June 2017

Provider News - August 2017

Provider News - November 2017

Provider News - December 2017

Provider News - February 2018

Provider News - April 2018

Provider News - June 2018

MA00.033s, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers

00.10.01an, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers

Justice-Involved (JI) Reentry Initiative: Updates to JI Microlearning Titles

Medical and Clinical Policy Updates - Effective October 1, 2026

Upcoming Maintenance: Prior Authorization Tool

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management