What types of policy changes does HealthSpring issue?

HealthSpring regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does HealthSpring update its policies?

HealthSpring typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many HealthSpring policy changes are tracked here?

This page currently tracks 7 documented HealthSpring policy changes. New items are added as they are identified.

What should I do when HealthSpring changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

HealthSpring Policy Changes & Prior Auth Updates

We track 7 documented policy changes from HealthSpring. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original HealthSpring notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new HealthSpring updates automatically.

High impact
Prior Authorization Changes Effective Oct. 1, 2026
HealthSpring·Effective Oct 1, 2026
HealthSpring Medicare Advantage is expanding prior authorization requirements effective October 1, 2026 to include four new service categories: oncology codes, specialty infusion drug codes, molecular and genetic diagnostic codes, and miscellaneous codes. These will be reviewed by HealthSpring or EviCore healthcare. Billing teams must verify prior authorization requirements before rendering services or face claim denials and payment recovery restrictions.
Medium impact
Coming Soon: New Online Form to Add Practitioners and Update Locations
HealthSpring·Effective Aug 13, 2026
HealthSpring is launching a new online Provider Data Intake form effective August 13, 2026, that allows participating providers to add new practitioners and service locations, upload multiple entries via roster templates, track request status in real time, and download PDF copies for compliance. This streamlines the provider credentialing and location update process through a self-service portal.
High impact
Review Steps for Direct Admission to Postacute Settings
HealthSpring·Effective Jul 30, 2026
HealthSpring has issued updated guidance on prior authorization requirements for direct admissions to postacute settings (skilled nursing facilities, inpatient rehabilitation, long-term acute care, and home health). Billing teams must ensure three prerequisites are met before submitting prior authorization: medical necessity assessment, physician order and medical clearance, and bed availability confirmation. Requests should be submitted through the Availity® Essentials provider portal.
Medium impact
Watch for Your Access and Availability Survey
HealthSpring·Effective Aug 1, 2026
HealthSpring will conduct a mandatory Medicare Advantage appointment wait times and after-hours access survey in August 2026, contacting a random sample of contracted providers via email or mail. Providers must respond to this CMS-required survey to demonstrate network accessibility compliance. All Medicare Advantage providers are expected to adhere to CMS-established wait time standards for primary care, specialist care, and behavioral health services.
Medium impact
Encourage Medicare Members to Respond to Health Outcomes Survey
HealthSpring·Effective Jul 15, 2026
CMS is conducting its annual Health Outcomes Survey for Medicare members from mid-July through early November 2026. Providers should encourage Medicare members to complete the survey when contacted, and proactively discuss survey topics (physical health, mental health, physical activity, bladder control, fall prevention, and provider relationships) during patient encounters. Survey results directly impact the CMS Five-Star Quality Rating System, which affects plan performance metrics.
Medium impact
Complete Annual Special Needs Plan Model of Care Training
HealthSpring·Identified Aug 13, 2026
CMS requires all providers to complete annual Special Needs Plan (SNP) Model of Care training by December 31, 2026. This is a mandatory compliance requirement for providers serving SNP patients. The 10-minute training covers SNP types, care coordination, and quality rating improvements.
Low impact
Post-Visit Surveys Support Member Experiences
HealthSpring·Effective Jun 30, 2026
HealthSpring Medicare Advantage will automatically send post-visit surveys to members after PCP routine or sick visits to measure care quality across six areas. The billing team should be aware that claims for these visits trigger survey distribution, and providers should encourage members to complete surveys as they contribute to CMS Star Ratings. This is an informational policy with no billing code changes or workflow modifications required.

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HealthSpring Policy Changes 2026 | Prior Auth & Coverage Updates | PolicyChanges.app

Prior Authorization Changes Effective Oct. 1, 2026

Coming Soon: New Online Form to Add Practitioners and Update Locations

Review Steps for Direct Admission to Postacute Settings

Watch for Your Access and Availability Survey

Encourage Medicare Members to Respond to Health Outcomes Survey

Complete Annual Special Needs Plan Model of Care Training

Post-Visit Surveys Support Member Experiences