ExchangeCoverageMedium impact
New or Updated Policies – Effective Date September 28, 2026
Ambetter·IN · Urology, Nephrology·Medical Policy
Effective date
Sep 28, 2026
We identified it
Aug 26, 2026
Summary
MHS Health Indiana (Ambetter) is implementing a new clinical and payment policy (CP.MP.97) for Testing for Select Genitourinary Conditions effective September 28, 2026. This policy includes a payment edit, which may affect claim processing, authorization requirements, or billing rules for urological testing services on Marketplace plans. The full policy details are not provided in this announcement and must be reviewed on the MHS Indiana Clinical & Payment Policies portal.
Action Required
By September 28, 2026: Billing team must obtain and review the complete CP.MP.97 policy from MHS Health Indiana's Clinical & Payment Policies portal at https://www.mhsindianahealth.com to identify specific genitourinary testing codes affected by the payment edit. Update billing system rules, prior authorization workflows, and encounter documentation as required by the policy. Contact MHS Health Indiana provider services if clarification is needed on affected CPT/HCPCS codes or payment edits. Notify urology and nephrology providers of any new authorization requirements or billing changes. Failure to implement policy requirements may result in claim denials or payment reductions effective September 28, 2026.