All Insurance Policy Changes (Page 159)

Continuing from page 158. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Tribal FQHC FAQs Updated
Alaska Medicaid·Effective Feb 11, 2025
Alaska Medicaid has updated FAQs for Tribal Federally Qualified Health Centers (FQHCs), providing guidance on reimbursement options, off-site service delivery, and behavioral health services. Key changes include clarification that Tribal FQHCs can provide services outside facility walls (unlike tribal clinics which face restrictions after February 11, 2025) and details on three reimbursement methodologies including IHS All-Inclusive Rate options.
Medium impact
Second-Level Provider Appeals Process
Alaska Medicaid·Effective Jan 16, 2024
Alaska Medicaid has updated their second-level provider appeals process, requiring all appeals to include complete documentation within 60 days of the first-level decision. Appeals must meet specific criteria outlined in Alaska Administrative Code 7 AAC 105.280 or they will be returned unprocessed.
High impact
How to Submit Professional Claims through Health Enterprise
Alaska Medicaid·Identified Jun 21, 2026
Alaska Medicaid has updated their professional claims submission process through the Health Enterprise portal. Providers must use the online portal at medicaidalaska.com for claims submission, with new features including pre-submission auditing, claim templates, and specific attachment handling requirements.
Medium impact
How to Submit Institutional Claims through Health Enterprise
Alaska Medicaid·Effective Feb 1, 2024
Alaska Medicaid has updated their Health Enterprise portal procedures for submitting institutional claims (UB-04). The policy provides step-by-step instructions for electronic claim submission through the medicaidalaska.com portal, including two view options (UB-04 and 837-entry), attachment requirements, and void/replacement procedures.
Medium impact
Provider Training Schedule - Billing Through Health Enterprise
Alaska Medicaid·Effective Mar 6, 2024
Alaska Medicaid has scheduled mandatory training sessions for providers on billing through Health Enterprise system. Multiple sessions are available for both professional and institutional billing in March 2024, with registration required via email.
Low impact
Organization Administrator How-To Guidance
Alaska Medicaid·Identified Jun 21, 2026
Alaska Medicaid has updated guidance for Organization Administrators who manage user access to the Health Enterprise portal system. This administrative update provides step-by-step instructions for adding, deactivating, unlocking, and managing user accounts for staff who submit claims and check eligibility.
Low impact
Remittance Advice Review Options FAQ
Alaska Medicaid·Effective Mar 4, 2024
Alaska Medicaid has published an FAQ providing alternative methods for providers to review Remittance Advices. Providers can access remittances through the Alaska Medicaid Health Enterprise Provider Portal, direct links in messages, or by using the Payment Inquiry search function in the Claims menu.
Low impact
Member Eligibility Check Options FAQ
Alaska Medicaid·Effective Mar 4, 2024
Alaska Medicaid has updated their member eligibility verification options, providing providers with multiple methods including the Health Enterprise Provider Portal, fax forms, automated voice response system, member cards, and phone inquiry. This is an informational update clarifying existing verification processes rather than introducing new requirements.
Low impact
Claim Submission Options FAQ
Alaska Medicaid·Identified Jun 21, 2026
Alaska Medicaid has updated their claims submission options FAQ, providing multiple methods for claim submission including the Health Enterprise Provider Portal, hard-copy paper submissions, and HIPAA compliant electronic transactions. The portal provides 2-3 business day access and allows eligibility checks, claim submission, and remittance review.
Medium impact
2024 Q1 DME Quarterly Town Hall FAQ
Alaska Medicaid·Effective Apr 1, 2024
Alaska Medicaid has updated DME billing requirements for oxygen equipment, including new capped rental periods beginning April 2024, acceptance of electronic CMN orders, and clarifications on billing procedures for multiple equipment deliveries to different locations.
Medium impact
Pharmacy Program Updates September 2023
Alaska Medicaid·Effective Nov 1, 2023
Alaska Medicaid is updating their Preferred Drug List effective November 1, 2023, and adding 29 new medications to the prior authorization list. New clinical prior authorization criteria are being established for specific high-cost medications including gene therapies and specialty drugs.
Medium impact
Pharmacy Program Updates November 2023
Alaska Medicaid·Effective Jan 1, 2024
Alaska Medicaid is updating its Preferred Drug List effective January 1, 2024, and adding 25 new medications to the prior authorization requirement list while removing 2 medications from prior auth requirements. Several existing medications are also having their clinical criteria updated.
Medium impact
Pharmacy Program Updates April 2024
Alaska Medicaid·Effective Jun 1, 2024
Alaska Medicaid is updating their Preferred Drug List and implementing new prior authorization requirements for 19 new medications, while removing prior auth for Ergocalciferol 50,000 unit capsule. Updated quantity limits will also apply to select medications.
Medium impact
April 2024 Town Hall Presentation
Alaska Medicaid·Identified Jun 21, 2026
Alaska Medicaid has updated their fiscal agent processes including new mailing addresses for different submission types, updated forms for appeals/adjustments/voids, and stricter provider enrollment requirements. The Allscripts portal (formerly Payerpath) support contact has been clarified, and denied claims can no longer be voided or adjusted - only resubmitted as new claims.
Medium impact
April 2024 Town Hall FAQ
Alaska Medicaid·Effective Apr 17, 2024
Alaska Medicaid released comprehensive FAQ guidance from their April 2024 Town Hall covering enrollment processes, claims submission procedures, and operational updates. Key changes include prioritized clearinghouse changes due to the Change Healthcare cyberattack (processed within 2 days), updated DME invoice requirements (invoices must be no more than 6 months old), and clarification that secondary claims must include other insurance EOBs as attachments.
Low impact
Superseded Travel Guidance:Member Passes During Travel Event
Alaska Medicaid·Effective May 22, 2024
Alaska Medicaid updated their policy for when members pass away during approved out-of-area travel. The policy clarifies that while Medicaid coverage ends on the date of death, Alaska Medicaid will cover transportation costs to fly approved escorts home, including ground transportation, meals and lodging up to 1 day after death, and airfare up to 7 days after death if no-show policies are followed.
Low impact
Revised Travel Guidance:Member Passes During Travel Event
Alaska Medicaid·Effective Jun 7, 2024
Alaska Medicaid will now cover escort transportation costs (flights, ground transport, meals, lodging) when returning home after a member passes away during approved out-of-area travel. Coverage extends up to 1 day for ground expenses and up to 10 days for airfare if no-show policies are followed.
Medium impact
Back-up Ventilator vs. Multiple Medically Necessary Devices
Alaska Medicaid·Effective Jul 15, 2024
Alaska Medicaid clarified that backup ventilators are not covered, but multiple medically necessary ventilators serving different purposes may be approved on a case-by-case basis. Prior authorization requests for second CPAP/BiPAP devices will be denied regardless of medical condition.
Medium impact
Simplified Travel Request Process
Alaska Medicaid·Effective Sep 1, 2024
Alaska Medicaid is implementing a simplified travel request process starting September 1, 2024, with new consolidated forms for different types of medical transportation requests and reduced documentation requirements for local travel escorts.
Medium impact
Updated 2024 Pharmacist Renderer Billing Guidance
Alaska Medicaid·Effective Sep 16, 2024
Alaska Medicaid will begin covering pharmacists' non-dispensing services under a fee-for-service model effective September 16, 2024. Individual pharmacists must enroll as rendering providers and be affiliated with specific organization types to bill for these services.
High impact
Pharmacist Professional Billing FAQ
Alaska Medicaid·Effective Aug 9, 2024
Alaska Medicaid has established new billing procedures for pharmacist professional services including prescribing, medication counseling, and vaccination services. Pharmacists must enroll as Alaska Medicaid providers and affiliate with Pharmacy Professional Groups to bill for non-dispensing services using CMS-1500 forms.
Medium impact
2024 Q2 DME Quarterly Town Hall FAQ
Alaska Medicaid·Effective Jul 1, 2024
Alaska Medicaid DME providers clarified billing and authorization processes, including that B4158 claims should no longer require NDC information after July 1, 2024, incontinence T code claims are being reprocessed, and new CMN forms become required October 1, 2024.
Medium impact
2024 Q2 DME Quarterly Town Hall Presentation
Alaska Medicaid·Identified Jun 21, 2026
Alaska Medicaid is seeking sole source DME providers for incontinence supplies and oral enteral nutrition products through RFI process, with responses due July 5, 2024. The policy also provides guidance on using DSM (secure email) system for submitting service authorization requests and claims attachments.
High impact
February 2024 Town Hall Presentation
Alaska Medicaid·Effective Apr 1, 2024
Alaska Medicaid is implementing new prior authorization requirements for 39 specific physician-administered drugs (PADs) including high-cost biologics and specialty medications effective April 1, 2024. Service authorizations must be requested through HMS fiscal agent via form submission through fax or new Direct Secure Messaging (DSM) system.
Medium impact
February 2024 Town Hall FAQ
Alaska Medicaid·Effective Feb 21, 2024
Alaska Medicaid updated travel escort requirements and documentation standards for non-emergency medical transportation. Key changes include stricter medical necessity documentation for adult escorts, updated contemporaneous documentation requirements for COMN forms, and clarification on chart note requirements for high-risk pregnancies requiring travel more than 30 days before delivery.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Tribal FQHC FAQs Updated

Second-Level Provider Appeals Process

How to Submit Professional Claims through Health Enterprise

How to Submit Institutional Claims through Health Enterprise

Provider Training Schedule - Billing Through Health Enterprise

Organization Administrator How-To Guidance

Remittance Advice Review Options FAQ

Member Eligibility Check Options FAQ

Claim Submission Options FAQ

2024 Q1 DME Quarterly Town Hall FAQ

Pharmacy Program Updates September 2023

Pharmacy Program Updates November 2023

Pharmacy Program Updates April 2024

April 2024 Town Hall Presentation

April 2024 Town Hall FAQ

Superseded Travel Guidance:Member Passes During Travel Event

Revised Travel Guidance:Member Passes During Travel Event

Back-up Ventilator vs. Multiple Medically Necessary Devices

Simplified Travel Request Process

Updated 2024 Pharmacist Renderer Billing Guidance

Pharmacist Professional Billing FAQ

2024 Q2 DME Quarterly Town Hall FAQ

2024 Q2 DME Quarterly Town Hall Presentation

February 2024 Town Hall Presentation

February 2024 Town Hall FAQ