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Medical and Clinical Policy Updates - Effective November 1, 2026
Act
by Oct 15, 2026
Effective date
Nov 1, 2026
Identified
Aug 25, 2026
Summary
Sentara Health Plans has updated 45+ medical policies effective November 1, 2026, including revisions to urinary incontinence treatments, cardiac implants, electrical stimulation, and extensive diagnostic testing policies (genetic, pathogen, cancer screening, biomarker testing). Multiple policies were archived (coccygectomy, gait analysis, oral incontinence treatments, injectable fillers). This is a comprehensive refresh affecting prior authorization requirements, coverage criteria, and billing across multiple service lines.
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What to do
by Oct 15, 2026 · 6 steps
01Billing team must access the complete revised policies at sentarahealthplans.com and pal.sentarahealthplans.com to identify specific billing code changes, prior auth requirements, and coverage criteria for all 45+ updated policies.
02Update billing software system to reflect new prior authorization requirements for revised policies (Medical 130, Surgical 106, Medical 349, Medical 350, Surgical 131, Medical 344, DME 04, DME 41, DME 42, and all Avalon G and M codes listed).
03Remove archived policies from internal coverage guidelines and billing workflows (Surgical 114, Medical 345, Medical 153, Surgical 220).
04Verify which policies apply to your specific service lines (Commercial, Medicaid, Medicare) and update encounter forms accordingly.
05Distribute updated policy summaries to providers by November 1, 2026 effective date.
06Claims submitted without compliance to new requirements may be denied or require rework.
Original notice
Medical and Clinical Policy Updates - Effective November 1, 2026
shc-p-001.sitecorecontenthub.cloud · Always check the source before changing claims.
Related changes
See all Sentara Health Plans changes →Medical and Clinical Policy Updates - Effective November 1, 2026MediumNo effective date · Medical PolicyMedical and Clinical Policy Updates - Effective December 1, 2026HighEffective Dec 1, 2026 · Medical PolicyMedical and Clinical Policy Updates - Effective October 1, 2026HighEffective Oct 1, 2026 · Medical PolicyMedical and Clinical Policy Updates - Effective September 1, 2026MediumEffective Sep 1, 2026 · Medical PolicyBrowse every Sentara Health Plans change in the policy list