CommercialCoverageMedium impact
Medical Policy Updates - January 2027
Sentara Health Plans·Ophthalmology·Medical Policy
Effective date
Jan 1, 2027
We identified it
Oct 16, 2026
Summary
Sentara Health Plans has revised Medical Policy 60 for Ophthalmic Procedures, effective January 1, 2027. This change applies to Commercial and Medicaid service lines. The billing team should verify the specific revisions to this policy to understand any changes to coverage, prior authorization requirements, or billing procedures for ophthalmic surgical procedures.
Action Required
By January 1, 2027: Billing team should access the revised Sentara Health Plans Medical Policy 60 (Ophthalmic Procedures) at sentarahealthplans.com and review the specific changes to understand any updates to prior authorization requirements, billing codes, or coverage criteria for ophthalmic procedures. Update billing workflows and staff training in the practice's billing system to reflect any new requirements for Commercial and Medicaid claims. Verify current applicability and confirm that the practice's encounter forms and authorization processes align with the revised policy prior to the effective date.