Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
HealthSpringMedicare Advantage · Prior Auth · Prior Authorization · Oncology, Allergy & ImmunologyHigh impact

Prior Authorization Changes Effective Oct. 1 and Nov. 1, 2026

Effective date
Oct 1, 2026
Identified
Sep 11, 2026

Summary

HealthSpring Medicare Advantage is changing prior authorization requirements for HealthSpring and EviCore, effective in two phases: Oct. 1, 2026 (removal/replacement of oncology codes, removal of immunology and molecular diagnostic codes from HealthSpring review) and Nov. 1, 2026 (addition of oncology drug codes to EviCore review). Billing teams must verify current prior authorization requirements through Availity Essentials before rendering services, as claims without required prior auth will be denied.

Get alerts when payers change rules like this one

We check HealthSpring and other payers every day and email you when a change matches your specialty and state.

Get HealthSpring alertsPolicy Monitoring is free. No card required.

What to do

Action · 10 steps
01By Sept.
0230, 2026: Billing team must update all workflows to reflect the Oct.
031 prior authorization changes.
04In billing system and Availity Essentials: Remove prior authorization requirement for the immunology code and molecular diagnostic code previously requiring HealthSpring review.
05Update or replace oncology codes in system to reflect new prior authorization requirements through HealthSpring.
06Train all billing and front-desk staff to verify prior authorization requirements through Availity Essentials or preferred vendor BEFORE rendering ANY services for HealthSpring Medicare Advantage members.
07By Oct.
0831, 2026: Update billing system to add oncology drug codes requiring EviCore review, effective Nov.
091, 2026.
10Communicate new requirements to providers and clinical staff.
If missed: Failure to obtain required prior authorization will result in claim denials, and providers may not seek reimbursement from members.

Original notice

Prior Authorization Changes Effective Oct. 1 and Nov. 1, 2026
healthspring.com · Always check the source before changing claims.
View original ↗

Related changes

See all HealthSpring changes →
Prior Authorization Changes Effective Jan. 1, 2027HighEffective Jan 1, 2027 · Prior AuthorizationPrior Authorization Changes Effective Oct. 1, 2026HighEffective Oct 1, 2026 · Prior AuthorizationBrowse every HealthSpring change in the policy list

Related policy hubs

HealthSpring policiesOncologyAllergy & Immunology

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account