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OfficeLink Updates - September 2026 newsletter
Effective date
Dec 1, 2026
Identified
Aug 27, 2026
Summary
Aetna's September 2026 newsletter announces multiple billing and operational changes affecting Aetna members across commercial and Medicare plans. Key changes include new claim edits effective December 1, 2026 via the Claim and Code Review Program (CCRP), restructured maternity care coding effective January 1, 2027, updated pharmacy drug lists effective January 1, 2027, and a push toward digital prior authorization integrated into EHR workflows. Practices must update provider directory information and review state-specific policies.
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What to do
Action · 15 steps
01REQUIREMENTS:
By November 15, 2026: Billing team must prepare for new claim edits from the Claim and Code Review Program (CCRP) effective December 1, 2026.
02Review the provider portal on Availity to identify all new claim edits that will be applied to commercial, Medicare, and Student Health member claims.
03Update internal billing policies and staff training documentation to reflect these edits to prevent claim denials.
04Before January 1, 2027: Billing team and clinical staff must transition maternity care coding to the new AMA/ACOG service-based framework (away from global maternity billing model).
05Update billing software rules, encounter templates, and provider documentation requirements to support detailed service-based coding for maternity services.
06This is a mandatory industry-wide change affecting all maternity claims.
07Before January 1, 2027: Pharmacy team must identify in-network pharmacy changes effective January 1, 2027.
08If your practice refers patients to any pharmacy leaving the network or has been using out-of-network pharmacies, identify replacement in-network pharmacies immediately.
09Update patient referral lists and communicate changes to clinical staff to prevent patient access issues and potential claim denials.
10Immediately: All providers must verify and update profile information in the Provider Data Management (PDM) tool on Availity.
11Outdated information could result in removal from the Aetna provider directory and failure to receive critical updates.
12Medicare providers must also update information in the National Plan and Provider Enumeration System (NPPES) to ensure accurate display in Medicare Plan Finder.
13Immediately: Credentialing departments must ensure current credentialing department email addresses are registered with Aetna to receive future policy updates and communications.
14As soon as possible: Evaluate digital prior authorization (PA) integration into your EHR workflow.
15Begin planning transition from manual PA processes to digital PA embedded in EHR systems to comply with evolving CMS requirements and reduce administrative burden.
Original notice
OfficeLink Updates - September 2026 newsletter
aetna.com · Always check the source before changing claims.
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