CommercialCoverageMedium impact
Medical and Clinical Policy Updates - Effective September 1, 2026
Sentara Health Plans·Dermatology, Sleep Medicine, Oncology +5 more·Medical Policy
Effective date
Sep 1, 2026
We identified it
Jun 15, 2026
Summary
Sentara Health Plans has updated 24 medical policies effective September 1, 2026, including reviews, revisions, and archival of existing policies across surgical, behavioral health, medical, and DME categories. Key changes include revised policies for wound treatment supplies, hearing aids/implants, sleep apnea surgery, and diabetes management, plus archival of policies for fetal cardiac imaging, continuous glucose monitoring, insulin pumps, and scalp cooling. Billing teams must identify which policies apply to their patient population and update authorization and coverage rules accordingly.
Action Required
By August 15, 2026: Billing and clinical teams must cross-reference all 24 updated policies against current patient claims and authorization workflows. For REVISED policies (Medical 343: Wound Treatment and Care Supplies; Surgical 20: Hearing Aids/Implants; Surgical 18: OSA Surgery; Medical 352: Diabetes Management; Evolent Guideline 7272: Coronary Artery Calcium Scoring), update billing system rules, prior authorization requirements, and coverage criteria in the system. For ARCHIVED policies (Surgical 09: Dermatologic Conditions; Medical 297: Fetal Cardiac Signal; DME 10: Continuous Glucose Monitoring; DME 11: Insulin Pump; DME 249: Scalp Cooling; Medical 324: Vision Therapy), remove prior authorization triggers and disable coverage rules to prevent inappropriate claim submissions. Update encounter templates and provider education materials. Access detailed policy content at sentarahealthplans.com and prior authorization list at pal.sentarahealthplans.com. Consequences: Claims submitted under archived policies will be denied; claims submitted without updated authorization requirements for revised policies may be denied or delayed.