ExchangeCoverageMedium impact
New or Updated Policies – Effective October 6, 2026
Ambetter·IN · Allergy & Immunology·Claims & Billing
Effective date
Oct 6, 2026
We identified it
Sep 12, 2026
Summary
MHS Health Indiana (Ambetter) is implementing a new Clinical Policy with Payment Edit for Allergy Testing and Therapy (CP.MP.100) effective October 6, 2026. The billing team must review the full policy details on the Ambetter provider portal to identify specific billing code changes, prior authorization requirements, or payment edits that will affect allergy-related claims for Indiana marketplace members.
Action Required
By October 1, 2026: Billing team must access the full policy text at https://www.ambetterhealth.com/en/in/provider-resources/clinical-payment-policies/ to identify specific CPT and HCPCS codes affected by CP.MP.100, any new prior authorization requirements, and payment edit rules. Update billing system, encounter templates, and staff workflows accordingly. Document all changes and communicate to allergy providers. Failure to implement changes may result in claim denials or payment reductions for allergy testing and therapy services for Ambetter Indiana marketplace members beginning October 6, 2026.