All Insurance Policy Changes (Page 34)

Continuing from page 33. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
Clinical documentation required for medical policy prior authorizations
UPMC Health Plan·Effective Jun 26, 2026
UPMC Health Plan is implementing a mandatory clinical documentation submission requirement for prior authorizations effective June 26, 2026. Beginning that date, six specific procedures (external beam radiation therapy, SRS/SBRT, laparoscopic cholecystectomy, sleep studies, lumbar spinal decompression, and implantable cardiac devices) will require all supporting clinical documentation to be uploaded during online authorization submission to avoid delays or denials.
Medium impact
Medical device correction: Omnipod (Insulet – May 2026)
UPMC Health Plan·Effective May 1, 2026
Insulet Corporation has issued a medical device correction for certain Omnipod insulin delivery pods due to potential tubing tears that may cause insulin leakage and dangerous high blood glucose levels. Affected patients should check their pod lot numbers at omnipod.com/mdc/check-pod-lot and request free replacements. Billing teams should be aware that patients may seek medical services related to this correction or file claims for affected devices.
Low impact
PA DOH Antibiotic Stewardship Resources
UPMC Health Plan·Identified Aug 7, 2026
The Pennsylvania Department of Health is offering free printed antibiotic stewardship materials for healthcare practices to order and display in provider-only areas. This is an informational resource initiative with no direct billing impact, available through June 12, 2026.
Low impact
CME Webinar: Lifestyle Medicine in Practice: Evidence‑Based Strategies for Chronic Disease Care
UPMC Health Plan·Identified Aug 7, 2026
This is a CME educational webinar announcement for providers on lifestyle medicine strategies for chronic disease management. This is an informational/educational announcement, not a billing policy change. No billing codes, coverage, reimbursement, or workflow changes are required.
Medium impact
Provider OnLine Multi-Factor Authentication Enhancements coming soon
UPMC Health Plan·Effective Jun 25, 2026
UnitedHealth Provider OnLine portal will require multi-factor authentication (MFA) for all user logins starting June 25, 2026. This security enhancement adds an extra layer of protection beyond passwords. Billing teams and providers must set up MFA before the effective date to maintain portal access for claims submission and authorization activities.
Medium impact
Voluntary nationwide recall: Dexcom G7 sensors (June 2026)
UPMC Health Plan·Effective Jun 1, 2026
Dexcom, Inc. is conducting a voluntary nationwide recall of two specific lots of Dexcom G7 glucose monitoring sensors (lots 1725204004 and 1725069002) due to theft and potential quality issues including improper sterilization and missing sensor readings. Patients with affected lots should stop use immediately and contact Dexcom Customer Support at 844-478-1600 for replacement sensors. The billing team should be prepared to handle replacement sensor claims and potential claim adjustments for affected patients.
Low impact
CME/CEU Webinar: Bright Beginnings: The Role of Medical and Dental Providers in Early Oral Health
UPMC Health Plan·Effective Aug 24, 2026
UPMC Health Plan is hosting a CME/CEU-accredited educational webinar on August 24, 2026, focused on early childhood oral health for medical and dental providers. This is an informational announcement about a professional development opportunity, not a billing or coverage policy change.
Medium impact
Important information regarding Medicare GLP-1 Bridge through CMS
UPMC Health Plan·Effective Jul 1, 2026
CMS is launching the Medicare GLP-1 Bridge demonstration program effective July 1, 2026, to provide GLP-1 medications for weight reduction to eligible Medicare Part D beneficiaries who don't qualify through their Part D plan and don't have type 2 diabetes, moderate-to-severe sleep apnea, or MASH. This program operates outside Part D with centralized prior authorization and claims processing through a dedicated processor.
Low impact
Virtual Institute: Bridging the Gap: Foundations of Integrated Care CME Courses Available
UPMC Health Plan·Identified Aug 7, 2026
This is an educational announcement about free CME courses on integrated care offered by UPMC. The Virtual Institute series focuses on lifestyle medicine, medical conditions mimicking psychiatric symptoms, sleep medicine, and nicotine addiction in adolescents. This is not a billing policy change and does not affect claims processing, coding, coverage, or reimbursement.
Low impact
Give feedback on your experience with UPMC Health Plan
UPMC Health Plan·Identified Aug 7, 2026
UPMC Health Plan is inviting a random sampling of in-network primary care providers to participate in a 2026 Press Ganey provider satisfaction survey. This is an informational announcement with no billing, coding, or coverage changes. Participation is voluntary and survey invitations will arrive via mail or email next month.
Low impact
Prescription for Wellness - Leveraging Insurance Carrier Resources to Optimize Patient Engagement Outcomes!
UPMC Health Plan·Identified Aug 7, 2026
UPMC Health Plan is promoting 'Prescription for Wellness,' a provider engagement program that allows providers to prescribe health coaching and care management resources to UPMC Health Plan members. This is an educational announcement about an existing program with a CME-accredited webinar, not a billing or coverage policy change.
High impact
August 2026 UPMC for You and UPMC Community HealthChoices Formulary Updates
UPMC Health Plan·Effective Aug 15, 2026
Effective August 15, 2026, UPMC for You and UPMC Community HealthChoices are moving multiple drugs and medical supplies to nonpreferred status, including common medications (dicyclomine, cevimeline, potassium formulations, bowel prep solutions) and most pen needles and lancets except for specific preferred brands. All nonpreferred items now require prior authorization before dispensing.
Medium impact
Voluntary nationwide recall: Cetirizine (Unique – July)
UPMC Health Plan·Effective Jul 20, 2026
Unique Pharmaceutical Laboratories is recalling four lots of Cetirizine Hydrochloride Tablets USP 5 mg due to cross-contamination with Ranitidine. Affected lots (GY825029, GY825030, GY825031, GY825032) contain red dots on tablets and pose risk of severe allergic reactions. The billing team must alert patients and providers to verify medication lot numbers and stop use of affected inventory immediately.
Low impact
Watch for a chance to rate your experience with UPMC Health Plan
UPMC Health Plan·Identified Aug 7, 2026
UPMC Health Plan is conducting a 2026 Press Ganey provider satisfaction survey and will randomly select in-network providers to participate. Invitations will arrive by mail or email in the coming weeks. This is an informational announcement about a voluntary survey initiative, not a billing or reimbursement policy change.
Low impact
Standing Order for Doula Services Reissued
NY Medicaid·Identified Aug 7, 2026
This is a New York State Medicaid policy bulletin announcing a 30-day public comment period (open through August 21, 2026) for the Section 1115(a) Medicaid Redesign Team (MRT) waiver extension application. The policy outlines continuation and amendments to existing Medicaid initiatives including managed care, HRSN services, SUD treatment, and workforce programs, with no immediate billing changes required at this time.
Medium impact
Guidance for Centers for Medicare and Medicaid Services Cell and Gene Therapy Access Model
NY Medicaid·Effective Apr 1, 2027
New York State is requesting a five-year extension of its Section 1115(a) Medicaid Redesign Team (MRT) demonstration waiver, scheduled to expire March 31, 2027. The extension proposes to continue existing Medicaid managed care programs, long-term care services, and health-related social needs (HRSN) services, while discontinuing coverage for TANF adults and closing out workforce training initiatives. A 30-day public comment period is open through August 21, 2026, with a second public hearing scheduled for August 11, 2026.
Medium impact
New York State Department of Health Announces Modernized Medicaid Provider Revalidation Process
NY Medicaid·Effective Apr 1, 2027
New York State Department of Health is requesting a five-year extension of the Section 1115(a) Medicaid Redesign Team (MRT) demonstration waiver, scheduled to expire March 31, 2027. A 30-day public comment period is now open (closes August 21, 2026) with virtual and in-person hearings scheduled. The extension proposes to continue existing Medicaid managed care programs, long-term care services, substance use disorder treatment, and Health-Related Social Needs (HRSN) services with limited amendments, including discontinuation of coverage for TANF adults and phased closure of workforce initiatives.
Medium impact
Public Hearing Schedule
NY Medicaid·Identified Aug 7, 2026
New York State is requesting a five-year extension of its Section 1115(a) Medicaid Redesign Team (MRT) demonstration waiver, scheduled to expire March 31, 2027. A 30-day public comment period is open until August 21, 2026, with a second public hearing on August 11, 2026. The extension proposes to continue current Medicaid managed care initiatives, amend workforce and Health-Related Social Needs (HRSN) programs, and discontinue coverage for TANF adults.
Medium impact
30-Day Public Comment Period Opened for the 1115 Medicaid Redesign Team Waiver Extension Application
NY Medicaid·Identified Aug 7, 2026
New York State is requesting a five-year extension of its Section 1115(a) Medicaid Redesign Team (MRT) demonstration waiver, scheduled to expire March 31, 2027. A 30-day public comment period is open through August 21, 2026, with proposed amendments to workforce initiatives, HRSN services, and elimination of coverage for TANF adults. Billing teams should monitor for potential coverage changes and service discontinuations that may affect NYS Medicaid claims processing.
High impact
Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions
Medicare/CMS - LCD·Effective Sep 4, 2025
This policy (L37790) for Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) for neurologic conditions has been RETIRED effective 7/31/2026. The policy is no longer active and should not be used for billing or coverage determinations. Billing teams must immediately stop referencing this policy and confirm current coverage guidance with CGS Administrators, LLC.
High impact
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
Medicare/CMS - LCD·Identified Aug 7, 2026
CRITICAL ALERT: This Local Coverage Determination (LCD L37421) for MRgFUS tremor treatment has been RETIRED as of 7/31/2026. This policy is no longer active and should not be used for billing or coverage decisions. Billing teams must immediately cease using this policy as a reference and verify current coverage status with Wellpoint Federal or consult the CMS Medicare Coverage Database for any replacement guidance.
High impact
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
Medicare/CMS - LCD·Effective Jul 31, 2026
⚠️ CRITICAL: This policy (LCD L37761 for MRgFUS Essential Tremor) has been RETIRED as of 7/31/2026. The policy is no longer active and should not be used for billing or coverage determinations. Palmetto GBA (MAC Part A/B) no longer provides local coverage guidance for this procedure under this LCD. Practices must verify current coverage status with the contractor or CMS before billing.
High impact
[Indiana] Claims Submission and Matching Logic Reminder
CareSource·Effective Jan 1, 2023
This is a reminder that Indiana Medicaid claims must be submitted with three specific data elements that must match in the state's system: the billing provider's NPI, their taxonomy code, and their billing service location zip code + 4 on file in CoreMMIS. Claims failing to meet this one-to-one matching logic will be rejected or denied, and previously paid claims may be recouped.
High impact
Reimbursement Rate Update for CSHCN Procedure Code E1032 Effective April 1, 2025
Texas Medicaid·Effective Apr 1, 2025
Effective April 1, 2025, TMHP is updating reimbursement rates for HCPCS code E1032 (durable medical equipment) under the Texas CSHCN Services Program. Prior authorization is now required for this code. TMHP will automatically reprocess affected claims, with adjustments appearing on future remittance reports.
Medium impact
Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective September 1, 2026
Texas Medicaid·Effective Sep 1, 2026
Effective September 1, 2026, Texas Medicaid & Healthcare Partnership (TMHP) is implementing reimbursement rate updates for specific HCPCS procedure codes used in the Children with Special Health Care Needs (CSHCN) Services Program. Billing teams must obtain and review the updated fee schedules from TMHP to ensure accurate reimbursement for affected codes.

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Insurance Policy Changes Tracker: All Payer Updates (Page 34) | PolicyChanges.app

Clinical documentation required for medical policy prior authorizations

Medical device correction: Omnipod (Insulet – May 2026)

PA DOH Antibiotic Stewardship Resources

CME Webinar: Lifestyle Medicine in Practice: Evidence‑Based Strategies for Chronic Disease Care

Provider OnLine Multi-Factor Authentication Enhancements coming soon

Voluntary nationwide recall: Dexcom G7 sensors (June 2026)

CME/CEU Webinar: Bright Beginnings: The Role of Medical and Dental Providers in Early Oral Health

Important information regarding Medicare GLP-1 Bridge through CMS

Virtual Institute: Bridging the Gap: Foundations of Integrated Care CME Courses Available

Give feedback on your experience with UPMC Health Plan

Prescription for Wellness - Leveraging Insurance Carrier Resources to Optimize Patient Engagement Outcomes!

August 2026 UPMC for You and UPMC Community HealthChoices Formulary Updates

Voluntary nationwide recall: Cetirizine (Unique – July)

Watch for a chance to rate your experience with UPMC Health Plan

Standing Order for Doula Services Reissued

Guidance for Centers for Medicare and Medicaid Services Cell and Gene Therapy Access Model

New York State Department of Health Announces Modernized Medicaid Provider Revalidation Process

Public Hearing Schedule

30-Day Public Comment Period Opened for the 1115 Medicaid Redesign Team Waiver Extension Application

Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions

Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor

Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor

[Indiana] Claims Submission and Matching Logic Reminder

Reimbursement Rate Update for CSHCN Procedure Code E1032 Effective April 1, 2025

Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective September 1, 2026