All Insurance Policy Changes (Page 51)

Continuing from page 50. 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
MMP 26-30: Enrollment of Limited Licensed Non-Physician Behavioral Health Providers and Updated Billing Requirements; Updates to Fee-for-Service (FFS) Program Billing of Level of Care Utilization System (LOCUS) and Michigan Child and Adolescent Needs and Strengths (MichiCANS) Screener Assessments
Michigan Medicaid - MDHHS·Effective Sep 1, 2026
Michigan Medicaid expands enrollment of limited licensed behavioral health providers (Master's level TLLPs, Limited Licensed Counselors, Educational Limited Licensed Marriage & Family Therapists, and Limited Licensed Master's level Social Workers) effective September 1, 2026. These providers must now enroll individually in CHAMPS, be uniquely identified on claims with their individual NPI in the rendering provider field, and work under supervision of a fully licensed provider. Additionally, FFS beneficiaries' LOCUS and MichiCANS Screener Assessments are now covered when performed by qualified providers.
High impact
MMP 26-31: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates
Michigan Medicaid - MDHHS·Effective Jul 1, 2026
Michigan Medicaid is implementing CPT/HCPCS code updates effective July 1, 2026, including new codes for physicians/clinics, hospitals, ASCs, and other providers; new coverage for existing codes; removal of prior authorization requirements for three equipment codes; and discontinuation of five codes. Additionally, a correction to hearing aid professional services billing clarifies separate reimbursement rules for conformity evaluations.
Low impact
Join us for a call with the BCBSRI Provider Relations team
Blue Cross Blue Shield of Rhode Island·Effective Aug 11, 2026
BCBS Rhode Island is hosting a provider conference call on August 11, 2026, from 10-11 a.m. to provide important updates and reminders. This is an informational invitation for providers to attend and submit questions in advance. A follow-up call is scheduled for September 8, 2026.
High impact
Telemedicine Modifier - Claims Edit Effective September 1, 2026
Blue Cross Blue Shield of Rhode Island·Effective Sep 1, 2026
Effective September 1, 2026, Blue Cross Blue Shield Rhode Island will implement a system edit that denies all claims submitted with telemedicine modifiers (93, 95, FQ, GT) if billed with any place of service code other than 02 (telehealth) or 10 (off-campus outpatient). Billing teams must ensure telemedicine modifiers are used exclusively with appropriate telehealth place of service codes to avoid automatic claim denials.
High impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
BlueCHiP for Medicare will now strictly follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) rather than applying independent policy determinations. Many existing BCBSRI policies are now commercial-only, and providers must reference BlueCHiP for Medicare's NCD and LCD policies separately. This is a foundational policy shift effective August 1, 2026.
Medium impact
New policies
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
Blue Cross Blue Shield Rhode Island has created two new medical policies effective August 1, 2026: one covering Closure Devices for Patent Foramen Ovale and Atrial Septal Defects, and another covering Facet Arthroplasty. The billing team must review the full policy text on BCBSRI.com to identify specific coverage criteria, billing codes, and prior authorization requirements for these procedures.
High impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·Effective Oct 1, 2026
This comprehensive policy update effective October 1, 2026, modifies coverage, prior authorization requirements, and billing procedures across 9 different medical services. Changes vary significantly by plan type (Medicare Advantage vs. Commercial), with some services moving from covered to non-covered, others gaining prior authorization requirements, and several undergoing administrative restructuring. Billing teams must implement plan-specific workflows immediately to avoid claim denials after the effective date.
High impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·Effective Sep 1, 2026
Effective September 1, 2026, claims submitted with telemedicine modifiers (93, 95, FQ, or GT) combined with in-office place of service codes (anything other than 02 or 10) will be automatically denied. Billing teams must ensure telemedicine modifiers are only used when place of service is coded as 02 (telehealth) or 10 (off-campus outpatient).
Medium impact
Provider notification: iDose TR (J7355) and Durysta (J7351)
Blue Cross Blue Shield of Rhode Island·Effective Sep 1, 2026
Effective September 1, 2026, iDose TR (J7355) and Durysta (J7351) will require prior authorization under the medical benefit with step therapy requirements. Patients must first trial and fail topical prostaglandin analogs (e.g., Travoprost eye drops) before these drugs can be approved.
Low impact
BCBSRI behavioral health urgent access appointments
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
BCBSRI has established a network of behavioral health providers in Rhode Island with dedicated urgent access appointment slots exclusively for BCBSRI members. Members can schedule appointments through the provider directly or via BCBSRI Behavioral Health Case Management. This is an informational update about access coordination, not a billing or coverage change.
Medium impact
BCBSRI Behavioral Health Case Management program
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
BCBSRI has launched a new Behavioral Health Case Management program staffed by mental health and substance use professionals, effective August 1, 2026. Providers can refer patients via phone (1-800-274-2958), email (triage_group@bcbsri.org), or automated portal form. This is a care coordination service, not a billable service, designed to assist with patient education, care coordination, and social determinant of health gaps.
Medium impact
New Virtual Provider Solution: Grow Therapy
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
BCBSRI is launching Grow Therapy, a new virtual behavioral health provider network offering telehealth therapy and medication management services to members nationally. Effective August 1, 2026, billing teams must recognize Grow Therapy as an in-network virtual provider option and ensure claims are routed correctly to avoid denials or out-of-network charges.
Medium impact
Diabetic measures
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
This policy emphasizes three key quality measures for diabetes care (KED, GSD, EED) that are part of the Medicare Stars program, effective August 1, 2026. The policy requires coordinated tracking and documentation of kidney function monitoring, glycemic control assessment, and diabetic retinal exams to close quality gaps and improve Star ratings.
Low impact
Astrana Health utilization management system transition
Blue Cross Blue Shield of Rhode Island·Effective Jul 1, 2026
Astrana Health transitioned to a new utilization management system effective July 1, 2026. Providers may continue submitting authorization requests via fax or telephone with no interruption in review operations. A new provider portal will be available with separate training information.
Low impact
Provider utilization management satisfaction survey
Blue Cross Blue Shield of Rhode Island·Effective Aug 1, 2026
BCBS Rhode Island has added a provider satisfaction survey to their Prior Authorization page on BCBSRI.com, accessible year-round for continuous feedback on utilization management (UM) services. This is an informational enhancement with no impact on billing workflows, coding, or claims processing.
Medium impact
eviCore portal change
Blue Cross Blue Shield of Rhode Island·Effective Jul 13, 2026
Effective July 13, 2026, eviCore will no longer accept authorization submissions through their portal for fully funded BCBS Rhode Island Commercial members. This supersedes the previous policy (effective October 1, 2025) that removed authorization requirements for fully funded Commercial members ordered by PCPs. Providers must stop submitting authorizations to eviCore's portal for these members after this date.
High impact
SNF HHA PT Coding
Blue Cross Blue Shield of Rhode Island·Effective Oct 1, 2026
BCBSRI is implementing a claims processing edit effective October 1, 2026, requiring that all therapy service claims submitted with revenue codes 042X, 043X, or 044X must include the appropriate therapy modifier (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) appended to the CPT code. Claims missing the required modifier or with an incorrect modifier will be denied.
High impact
[Georgia] August 2026 Pharmacy Policy Updates
CareSource·Effective Jul 1, 2026
CareSource Georgia Medicaid released five revised pharmacy policies effective July 1, 2026, covering medical benefit medications, off-label use medical necessity, multi-source brand medical necessity, preferred/non-preferred medication medical necessity, and multi-ingredient compound policies. The billing team must review each revised policy on CareSource.com to identify specific coverage, prior authorization, and documentation requirement changes before the July 1 effective date.
Medium impact
[Indiana] August 2026 Policy Updates
CareSource·Effective Oct 1, 2026
CareSource Indiana Medicaid released three policy updates effective October 1, 2026: a NEW Continuity of Care administrative policy (AD-1637), a REVISED Modifiers reimbursement policy (PY-1347), and a REVISED Medical Record Documentation Standards policy (AD-0754). The billing team must review full policy details online to identify specific workflow, coding, and documentation changes required.
Medium impact
[Ohio] Pharmacy Policy Updates August 2026
CareSource·Effective Nov 1, 2026
CareSource Ohio Medicaid is updating pharmacy policies for 14 specialty medications effective November 1, 2026. Five policies are newly added (AVLAYAH, LOARGYS, YARTEMLEA) and six existing policies are revised (Alpha1-Proteinase Inhibitor, Elaprase, Kanuma, Leqvio, Natalizumab, Vyvgart). Three policies undergo annual review with no changes. Billing teams must access the specific policy details via CareSource.com to understand coverage requirements, prior authorization rules, and reimbursement guidelines for each medication.
High impact
[Ohio] Billing Guidance
CareSource·Effective Sep 1, 2026
CareSource Ohio Medicaid issued comprehensive billing guidance effective September 1, 2026, clarifying six key compliance areas: laboratory services in hospital settings cannot be separately billed, fluoride varnish is limited to 2 applications/year for children under 21, physician interpretation-only codes must not include technical components, GZ modifier usage requires ABN documentation, add-on procedure codes require primary procedure codes, and inpatient ICD-10 codes must specify laterality (right/left/bilateral) rather than using unspecified codes. Providers must immediately review billing practices to avoid claim denials and potential recovery of payments found non-compliant with OAC and CMS rules.
Medium impact
Special Alert July 2026 - Update to Health Share’s Clinical Practice Guidelines
Providence Health Plan·Identified Aug 1, 2026
Health Share of Oregon has updated its Clinical Practice Guidelines, replacing CDC ACIP immunization guidelines with the AAP Immunization Schedule. Billing teams must review the updated guidelines at the provided link to identify any changes to covered immunization services, coding requirements, or clinical documentation standards that may affect claim submissions.
Low impact
R504PR1: Provides for calendar year (CY) inflation factors to update previous years’ reasonable compensation ranges. The factor is from the cost category Professional Fees: Labor Related in the CMS Prospective Payment System Hospital Input Price Index. Th
Medicare/CMS - Transmittals·Identified Aug 1, 2026
This policy document does not contain substantive billing, coding, or reimbursement changes. It is a resource guide listing CMS help desk contacts, hours of operation, and useful websites for Marketplace agents and brokers. The title references R504PR1 regarding inflation factors, but the actual policy content is missing—only support contact information is provided.
High impact
TMHP EDI Connectivity Change Rescheduled for September 1, 2026
Texas Medicaid·Effective Sep 1, 2026
TMHP has rescheduled the EDI connectivity transition from August 1, 2026 to September 1, 2026. Batch submitters must complete mandatory trading partner testing and migrate from VPN to SFTP connectivity by August 31, 2026, or lose EDI submission access and experience claims reimbursement delays starting September 1, 2026. This change applies only to batch submitters; real-time submitters are unaffected.
Low impact
Updated Texas Health Steps QRG Available August 1, 2026
Texas Medicaid·Effective Aug 1, 2026
TMHP will post an updated Texas Health Steps Quick Reference Guide (QRG) on August 1, 2026, containing punctuation, grammar, and editorial revisions. This is a routine administrative update to the reference guide. The policy reminds providers that Texas Medicaid MCOs must cover all medically necessary services, though administrative procedures like prior authorization and precertification may vary by MCO.

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Insurance Policy Changes Tracker: All Payer Updates (Page 51) | PolicyChanges.app

MMP 26-30: Enrollment of Limited Licensed Non-Physician Behavioral Health Providers and Updated Billing Requirements; Updates to Fee-for-Service (FFS) Program Billing of Level of Care Utilization System (LOCUS) and Michigan Child and Adolescent Needs and Strengths (MichiCANS) Screener Assessments

MMP 26-31: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

Join us for a call with the BCBSRI Provider Relations team

Telemedicine Modifier - Claims Edit Effective September 1, 2026

BlueCHiP for Medicare national and local coverage determinations policy

New policies

Medical policy updates

Payment policy updates

Provider notification: iDose TR (J7355) and Durysta (J7351)

BCBSRI behavioral health urgent access appointments

BCBSRI Behavioral Health Case Management program

New Virtual Provider Solution: Grow Therapy

Diabetic measures

Astrana Health utilization management system transition

Provider utilization management satisfaction survey

eviCore portal change

SNF HHA PT Coding

[Georgia] August 2026 Pharmacy Policy Updates

[Indiana] August 2026 Policy Updates

[Ohio] Pharmacy Policy Updates August 2026

[Ohio] Billing Guidance

Special Alert July 2026 - Update to Health Share’s Clinical Practice Guidelines

R504PR1: Provides for calendar year (CY) inflation factors to update previous years’ reasonable compensation ranges. The factor is from the cost category Professional Fees: Labor Related in the CMS Prospective Payment System Hospital Input Price Index. Th

TMHP EDI Connectivity Change Rescheduled for September 1, 2026

Updated Texas Health Steps QRG Available August 1, 2026