Medi-Cal is transitioning the Learning Portal (MLP) to a new platform in November 2026 with Single Sign-On (SSO) access through the Provider Portal or Outreach and Education page. Training announcements will reference course titles instead of direct links, requiring staff to search the new MLP interface to locate courses.
Action Required
Coming in November 2026: Inform staff who regularly access Medi-Cal training about the new MLP sign-in process (SSO through Provider Portal or Outreach and Education page) and the change from direct course links to course title searches. No billing workflow changes are required. To stay informed of the exact transition date and additional details, subscribe to the free Medi-Cal Subscription Service (MCSS) or monitor the Medi-Cal Providers website.
Effective November 1, 2026, Medi-Cal will update NEMT and NMT policies, including: NEMT TAR authorization periods capped at 6 months (or 12 months for chronic conditions) requiring new written prescriptions with ICD-10-CM diagnosis codes; NMT frequency limits for code A0120 (two one-way trips per day or five round trips per week) and mileage limits for code A0390 (50 miles maximum per trip); and enhanced documentation requirements for NMT claims. Billing teams must implement these limits, update prior authorization workflows, and ensure compliant claim submissions starting November 1, 2026.
Action Required
By November 1, 2026: (1) Billing team must update billing software to enforce frequency limits for HCPCS code A0120 (maximum two one-way trips per day or five round trips per week per member per provider) and mileage limits for code A0390 (maximum 50 miles per trip); (2) Prior authorization staff must implement new TAR approval logic capping authorization periods at 6 months for NEMT, or 12 months for chronic conditions, with requirement for new TAR and written prescription with ICD-10-CM diagnosis code to demonstrate continued need; (3) Billing team must verify that all NMT claims for codes A0120 and A0390 include documentation stating the member required NMT for Medi-Cal-covered medical, mental health, substance use, dental, or other services—missing documentation may trigger claims examiner review; (4) Providers and authorization staff should review updated provider manual requirements for NEMT written prescriptions and NMT member attestation verification when published. Claims exceeding frequency or mileage limits will be subject to claims examiner review, potentially resulting in denial or recoupment.
This is a clarification document from an Alaska Medicaid town hall meeting (held October 21, 2026) addressing frequently asked questions about travel authorization procedures, claims billing when TPL is involved, and general administrative processes. No new policies are announced; the document confirms existing procedures remain unchanged, clarifies voucher completion for ground travel, and provides contact information for the state travel team.
Action Required
No immediate action required. This document provides clarification on existing Alaska Medicaid procedures rather than announcing policy changes. Billing teams should note: (1) The new state travel team email (doh.hcs.medicaid.travel.info@alaska.gov) is for policy questions only, not travel requests; (2) When billing to Alaska Medicaid after a primary insurance claim, follow the primary insurance's billing code requirements—Alaska Medicaid will cross-walk codes to their required codes; (3) Travel procedures, contact points, and urgent request processes remain unchanged from prior guidance; (4) For behavioral health audit records from Optum, contact doh.dbh.mpassunit@alaska.gov with [Claims] in the subject line. Verify current applicability of these procedures with your RA messages and internal compliance documentation.
Effective February 1, 2027, Blue Cross Blue Shield of Oklahoma will implement enhanced claims review for laboratory, genetic, and molecular testing services. Claims for dates of service on or after that date will be reviewed by Concert (a third-party utilization management company) against AMA and CMS National Correct Coding Initiative guidelines to ensure proper coding. Denied claims will receive notification with next steps.
Action Required
By February 1, 2027: Billing team should ensure all laboratory, genetic, and molecular testing claims are coded according to current AMA and CMS National Correct Coding Initiative guidelines. Verify that claim submission processes align with these standards to minimize denials during the enhanced review process. Train staff on proper coding for these service categories and establish a process to monitor denied claims from Concert for patterns and corrective actions. No workflow changes are stated as required before the effective date, but proactive coding audits are recommended.
Medical Mutual of Ohio·Mutual News Newsletter·National, Oncology, Urology, Dermatology, Psychiatry, PM&R (Physical Medicine & Rehab), Radiology
Medical Mutual updated multiple medical policies effective November 1, 2026, with changes taking effect 90 days later (January 29, 2027) for material changes. Key updates include: removal of cryoablation coverage for hepatocellular carcinoma, prostate cancer, and renal cell carcinoma with specific CPT codes deleted; policy title revision for peripheral electrical stimulation device (Cala kIQ); deletion of CPT code 31237 and addition of 0373T for behavioral health services; and expansion of ICD-10 diagnosis codes requiring prior authorization review for rosacea treatment.
Action Required
By January 29, 2027: (1) Billing team should remove CPT codes 47371, 47381, 47383, 50250, 50542, and 50593 from cryoablation coverage policies and update billing system rules to use InterQual subsets (Ablative or Transarterial Therapy, Liver, Cryoablation, Prostate and Radiofrequency Ablation or Cryoablation, Renal) for coverage guidance. (2) Update billing system to delete CPT code 31237 and add CPT code 0373T for behavioral health applied behavior analysis (ABA) claims. (3) Modify prior authorization rules in billing software to flag claims with ICD-10 codes L71.1 (Rhinophyma) and L71.8 (Other rosacea) for PA review in addition to existing L71.9 (Rosacea, unspecified) for laser therapy treatment of cutaneous vascular lesions. (4) Remove CPT code 81450 from next-generation sequencing policies and update claim routing to use InterQual subsets for 81450 requests. Failure to implement these changes by the effective date may result in claims being processed under outdated coverage rules or denied due to deleted codes.
Medicare/CMS - NCD·National Coverage Determination·National, Cardiothoracic Surgery, Critical Care, Cardiology
This is a National Coverage Determination (NCD 20.9.1) for Ventricular Assist Devices that was last updated on 2026-10-26. The policy document itself does not contain specific change details, billing codes, effective dates, or actionable requirements in the provided extract. The billing team should access the full CMS policy text at the provided URL to determine current coverage criteria, coding requirements, and any recent modifications to VAD coverage rules.
Action Required
Billing team should review the complete National Coverage Determination 20.9.1 for Ventricular Assist Devices at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=360&ncdver=2 to confirm current coverage policies, required documentation, applicable billing codes, and any prior authorization requirements. Verify whether this update (dated 2026-10-26) represents a substantive policy change or a routine review. Document the current coverage criteria in the practice's billing compliance procedures and ensure all VAD-related claims are adjudicated according to the most recent determination.
Medicare/CMS - NCD·National Coverage Determination·National, Wound Care, General Surgery, Vascular Surgery
National Coverage Determination 20.29 for Hyperbaric Oxygen Therapy was updated on 2026-10-26. The source document does not provide specific policy content, billing codes, coverage changes, or effective dates beyond the last update date. The billing team should access the full policy text at the CMS Medicare Coverage Database to determine current coverage criteria, covered indications, billing codes, and any prior authorization requirements.
Action Required
Billing team should review the complete National Coverage Determination 20.29 policy at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=12&ncdver=4 to identify: (1) specific CPT or HCPCS codes for hyperbaric oxygen therapy covered under Medicare, (2) covered indications and medical necessity criteria, (3) any prior authorization requirements, and (4) whether the 2026-10-26 update modified previous coverage or billing guidance. Confirm current applicability of any changes and update billing workflows and documentation requirements accordingly. Document the policy version reviewed in compliance files.
This is a National Coverage Determination (NCD 260.9) for Heart Transplants that was last updated on 2026-10-26. The source document provided does not contain specific policy change details, billing codes, effective dates, or actionable requirements beyond the title and metadata. The billing team cannot determine what changed, what is newly covered or non-covered, or what workflow adjustments are needed without access to the full policy content comparing previous and current versions.
Action Required
Billing team should access the full NCD 260.9 policy text at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=112&ncdver=3 to identify: (1) specific changes made as of the 2026-10-26 update; (2) any source-stated effective dates for coverage or billing changes; (3) affected CPT, HCPCS, or ICD-10 codes; (4) prior authorization or documentation requirements; and (5) any plan-type or geographic limitations. Compare the current version against the previous version to confirm applicability to your practice workflows. Do not assume the 2026-10-26 update date is an effective date; extract only source-stated effective dates. Flag any changes to heart transplant coverage, candidate criteria, or reimbursement for provider and compliance review.
Medicare/CMS - NCD·National Coverage Determination·National, Cardiology, Critical Care, Internal Medicine
This is a National Coverage Determination (NCD 20.16) for Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB). The policy document was last updated on 2026-10-26, but the source provided does not contain specific coverage changes, effective dates, billing codes, or actionable requirements—only a reference to the CMS policy database entry.
Action Required
Billing team should access the full CMS Medicare Coverage Database entry (NCD 20.16, version 3) at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=267&ncdver=3 to retrieve the complete policy text, including coverage criteria, applicable billing codes, any prior authorization requirements, and effective dates. The summary provided does not contain sufficient detail to determine current coverage status or required billing actions. Verify whether TEB monitoring is covered under your practice's current Medicare contracts and confirm any documentation or authorization requirements before billing.
Effective January 1, 2027, members with unsatisfactory immigration status (UIS) will transition from Anthem Medi-Cal Managed Care to Medi-Cal Fee-for-Service (FFS). Community Health Worker (CHW) providers must complete care coordination and member transitions before the deadline, then enroll in Medi-Cal FFS to continue serving these members and bill DHCS directly for services after the transition.
Action Required
Before January 1, 2027: CHW care providers and supervising organizations must (1) coordinate with members' PCPs and clinical/behavioral health/county/community partners to minimize service disruptions; (2) verify whether current care providers can continue serving members through Medi-Cal FFS; (3) identify alternative Medi-Cal FFS care providers when necessary; and (4) assess whether members may qualify for behavioral health services, home and community-based services, county programs, or other available supports. CHW providers must continue delivering and billing Anthem for CHW services through December 31, 2026. Starting January 1, 2027: CHW supervising care providers who want to continue serving transitioning members must confirm enrollment in Medi-Cal FFS and be prepared to submit claims to the Department of Health Care Services (DHCS) rather than Anthem. Providers not already enrolled in Medi-Cal FFS must complete enrollment through PAVE (Provider Application and Validation for Enrollment). Failure to complete transition planning and coordination before the deadline may result in service disruptions for members and loss of billing revenue after January 1, 2027.