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Medical and Clinical Policy Updates - Effective December 1, 2026
Act
by Nov 24, 2026
Effective date
Dec 1, 2026
Identified
Sep 15, 2026
Summary
Sentara Health Plans has updated 27 medical and surgical policies effective December 1, 2026, including revisions to high-volume procedures like lumbar/cervical fusion, diabetes management, urinary incontinence treatment, and prescription digital therapeutics. Three DME policies (Needless Injections, Mechanical Stretching Devices, Home Traction Devices) have been archived and are no longer covered. Billing teams must review affected policies on the PAL and update prior authorization requirements accordingly.
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What to do
by Nov 24, 2026 · 7 steps
01Billing team must access pal.sentarahealthplans.com and sentarahealthplans.com to review all 27 updated policies, particularly Surgical policies 116-122 (fusion/laminectomy procedures), Medical 130 (incontinence), Medical 259 (digital therapeutics), and Medical 352 (diabetes).
02Update billing system rules and prior authorization workflows for revised policies (Surgical 119, 214; Medical 130, 259, 352).
03Remove archived DME policies (DME 26, 31, 35) from coverage lists in billing software and encounter forms—claims for these services will be denied effective 12/1/2026.
04Notify providers and clinical staff of policy changes via staff meeting or email.
05Test updated prior authorization rules in billing system before December 1.
06Action required by: Billing team, system administrators, and practice management.
07Consequences: Claims submitted under archived or outdated policies will be denied; failure to implement prior auth changes will increase claim rejections.
Original notice
Medical and Clinical Policy Updates - Effective December 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, 2026HighEffective Nov 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 PolicySpring 2026 Medical and Clinical Policy UpdatesHighEffective May 1, 2026 · Medical PolicyBrowse every Sentara Health Plans change in the policy list