All Insurance Policy Changes (Page 94)

Continuing from page 93. 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
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota·Effective Sep 9, 2026
BCBSND released comprehensive pharmacy policy updates effective September 9, 2026, affecting 20+ medications across oncology, immunology, rheumatology, and other specialties. Changes include new FDA-approved indications (e.g., Datroway for triple-negative breast cancer, Fasenra for HES, Imfinzi for bladder cancer), revised prior authorization criteria, updated ICD-10 diagnosis codes, new biosimilar products, and administrative restructuring of authorization durations. Billing teams must update systems to reflect new covered diagnoses, dosing parameters, and clinical criteria before the effective date.
High impact
Pharmacy Benefit Billing Tips
Blue Cross Blue Shield of North Dakota·Effective Jul 9, 2026
BCBS ND has updated pharmacy billing guidance to prevent duplicate billing of maintenance supplies when starter kits are dispensed. Billing teams must not bill maintenance supplies on the same claim as starter kits that already include those supplies. Maintenance supplies should only be billed after 70% or more of the starter kit supply is utilized (typically Day 21 or later for 30-day supplies).
High impact
What providers need to know now about affiliation impacts
Blue Cross Blue Shield of North Dakota·Effective Jan 1, 2027
Blue Cross Blue Shield of North Dakota is undergoing a strategic affiliation with Cambia Health Solutions. While current business processes remain unchanged, providers must prepare for significant system changes in 2027: approximately 65% of commercial members will migrate to a new claims processing system and receive new member ID numbers on January 1, 2027, with remaining members transitioning on their health plan renewal dates. BCBSND will provide training, FAQs, and office hours to support the transition.
High impact
[Ohio] Behavioral Health Time-based Service Documentation Requirement
CareSource·Effective Sep 1, 2026
CareSource Ohio Medicaid is changing behavioral health time-based service documentation requirements. Effective September 1, 2026, providers must document start and stop times for all behavioral health services; documentation showing only total time will no longer be accepted. Claims for dates of service on or after September 1, 2026 that lack start and stop times will be denied after medical record review.
Medium impact
[Indiana] Update to High Dollar Claims
CareSource·Effective Jul 8, 2026
CareSource Indiana (Medicaid and Marketplace) now requires providers to submit a completed Itemized Bill Cover Sheet with high-dollar claims (billed charges over $500,000) and claims flagged for itemized bill review. This applies to DRG claims, outliers, outpatient grouper pricing, and percent-of-charge contracts over $25,000. Missing documentation may delay or deny claims.
High impact
[Indiana] Partial Hospitalization Program – Reminders
CareSource·Effective Jul 14, 2026
CareSource issued a reminder bulletin on Indiana Medicaid PHP services clarifying prior authorization requirements, billing limits, and service standards. Key requirements include: prior authorization is mandatory; only one H0035 unit per date of service is allowed; services must be provided at least four days per week for 4-6 hours of active therapy; and inpatient services cannot be billed on the same date as PHP. Failure to comply may result in claim denials or recoupments.
Medium impact
Special Alert July 2026 - Update to Health Share’s Clinical Practice Guidelines
Providence Health Plan·Identified Jul 15, 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 which immunization codes and protocols have changed to ensure accurate claim submission and compliance with the new standards.
High impact
Provider Letter 2026-12: Re: D1354 Reimbursement Rate Update
Oklahoma SoonerCare·Effective Aug 1, 2026
Oklahoma Health Care Authority (OHCA) is reducing reimbursement rates for dental code D1354 (interim caries arresting medicament application) effective August 1, 2026. Rates are decreasing from $76.22 to $18.29 for children and from $83.93 to $20.14 for adults—a 76% reduction. Billing teams must update fee schedules and claims processing systems immediately to avoid payment delays and claim denials.
Medium impact
R13869FM: Notice of New Interest Rate for Medicare Overpayments and Underpayments -4th Quarter Notification for FY 2026
Medicare/CMS - Transmittals·Identified Jul 15, 2026
Failed to analyze policy change
Medium impact
STEPS Planned System Outage – July 17, 2026 to July 19, 2026
Texas Medicaid·Identified Jul 15, 2026
Failed to analyze policy change
Low impact
2026 LTCR Provider Webinar Training Opportunities
Texas Medicaid·Identified Jul 15, 2026
This is a training opportunity announcement for Long-Term Care Regulation (LTCR) providers across multiple facility types (nursing facilities, assisted living, ICF, HCSSA, etc.) to attend webinar courses in July and August 2026. This is informational guidance regarding professional education offerings, not a change to billing, coding, coverage, or clinical policies.
Medium impact
BT2026116: IHCP adds coverage for CTA scan of blood vessels in the head and neck with contrast
Indiana Medicaid (IHCP)·Effective Jul 1, 2026
Indiana Health Coverage Programs (IHCP) has added coverage for CTA scans of blood vessels in the head and neck with contrast (CPT 70471), effective immediately and retroactive to July 1, 2026. This change applies to both managed care and fee-for-service medical benefits.
Medium impact
BT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026
Indiana Medicaid (IHCP)·Identified Jul 15, 2026
Failed to analyze policy change
High impact
BT2026118: IHCP reminds ABA agencies of accreditation requirement
Indiana Medicaid (IHCP)·Effective Oct 1, 2027
IHCP requires all Applied Behavior Analysis (ABA) agencies to obtain accreditation from ACQ or BHCOE. Currently enrolled ABA providers must submit documentation of accreditation initiation by August 1, 2026, and must complete full accreditation by October 1, 2027, or their IHCP enrollment will be deactivated.
Medium impact
Opioid Antagonist Distribution Grant Information Session
Arizona Medicaid - AHCCCS·Identified Jul 15, 2026
Failed to analyze policy change
Low impact
AHCCCS Launches GenAI-Powered Provider Locator to Improve Access to Opioid Use Disorder Treatment Across Arizona
Arizona Medicaid - AHCCCS·Effective Jul 14, 2026
AHCCCS has launched a new GenAI-powered Opioid Use Disorder (OUD) Service Provider Locator tool to help patients find treatment services across Arizona. This is an informational tool for patient access to care and does not directly impact billing codes, prior authorization requirements, or reimbursement processes for healthcare providers.
Low impact
Building a better member experience through AI
Regence BlueCross BlueShield of Oregon·Identified Jul 15, 2026
Regence is implementing AI-powered tools to improve member experience and customer service efficiency, including a Customer Service Virtual Assistant (CVA) for internal use and a member-facing Regence Assistant for benefit questions. The policy emphasizes human oversight, privacy protection, and accuracy verification—this is primarily an operational/technology initiative rather than a billing or coverage change.
Medium impact
Provider News - May 2016
Security Health Plan·Identified Jul 15, 2026
Failed to analyze policy change
Medium impact
Provider News - January 2017
Security Health Plan·Effective Jan 1, 2017
Security Health Plan Medicare Advantage members now have access to routine eyeglasses stipends effective January 1, 2017, varying by plan ($150-$275). Providers must submit claims to Security Health Plan (not patient-paid claims) and choose one of three billing workflows to handle the stipend application and member balance collection.
High impact
Provider News - February 2017
Security Health Plan·Effective Feb 1, 2017
Security Health Plan requires decimal billing on time-based therapy codes (PT, OT, speech therapy) for BadgerCare Plus members when less than one full unit of service is provided. For example, 7.5 minutes of a 15-minute code should be billed as 0.5 units. The plan will audit therapy claims for accurate compliance with this requirement.
High impact
Provider News - March 2017
Security Health Plan·Effective Feb 1, 2017
Security Health Plan has released multiple new medical policies and updated existing ones effective January-February 2017, including 10 newly developed policies (Cryoablation, Gastric Pacing, Urinary Incontinence, Migraine/Cluster Headache management, and others) and updated criteria for existing procedures. Providers must obtain copies of these policies to ensure billing compliance, as payment requires meeting all outlined medical criteria. Prior authorization requirements for commercial plans remain in effect for office and outpatient-based procedures.
Medium impact
Provider News - May 2017
Security Health Plan·Effective Jun 1, 2017
Security Health Plan released its May 2017 Provider News containing three main items: (1) announcement of a new provider portal launching June 1, 2017 with enhanced prior authorization and eligibility verification features; (2) recognition of high-performing skilled nursing facilities; and (3) educational coding guidance on cerebrovascular accidents (CVA) for accurate ICD-10 CM coding. The provider portal transition requires practices to designate organization administrators and complete access requests before the June 1 launch.
High impact
Provider News - June 2017
Security Health Plan·Effective Nov 1, 2017
Security Health Plan is implementing new medical pharmacy management services through Magellan Rx effective November 1, 2017, requiring prior authorization for medical pharmaceuticals (drugs administered in medical settings). Additionally, colorectal cancer screening coverage policies are clarified across multiple plan types with specific frequency limits and alternative screening options promoted to improve member compliance.
Low impact
Provider News - August 2017
Security Health Plan·Identified Jul 15, 2026
This August 2017 Provider News from Security Health Plan is primarily informational, covering community opioid prevention initiatives, member health coaching success stories, fall prevention workshops, and updates to the provider portal. No direct billing code changes, coverage modifications, or reimbursement adjustments are announced. The portal updates include new FAQs regarding claims/eligibility permissions and prior authorization workflows.
High impact
Provider News - November 2017
Security Health Plan·Effective Nov 1, 2017
Security Health Plan implements multiple significant changes effective Nov 1 - Jan 1, 2018: (1) New prior authorization requirements for 2018 including cardiac valve replacement, femoro-acetabular surgery, MAZE procedures, and skin substitutes; (2) Pharmacy benefit manager transition from current provider to MedImpact effective Jan 1, 2018; (3) Magellan Rx prior authorization program for specific medications beginning Nov 1, 2017; (4) Updated Interqual 2017 clinical criteria for inpatient medical/behavioral health admissions effective Sept 1, 2017.

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Archive by year

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Pharmacy Policies Available Online

Pharmacy Benefit Billing Tips

What providers need to know now about affiliation impacts

[Ohio] Behavioral Health Time-based Service Documentation Requirement

[Indiana] Update to High Dollar Claims

[Indiana] Partial Hospitalization Program – Reminders

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

Provider Letter 2026-12: Re: D1354 Reimbursement Rate Update

R13869FM: Notice of New Interest Rate for Medicare Overpayments and Underpayments -4th Quarter Notification for FY 2026

STEPS Planned System Outage – July 17, 2026 to July 19, 2026

2026 LTCR Provider Webinar Training Opportunities

BT2026116: IHCP adds coverage for CTA scan of blood vessels in the head and neck with contrast

BT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026

BT2026118: IHCP reminds ABA agencies of accreditation requirement

Opioid Antagonist Distribution Grant Information Session

AHCCCS Launches GenAI-Powered Provider Locator to Improve Access to Opioid Use Disorder Treatment Across Arizona

Building a better member experience through AI

Provider News - May 2016

Provider News - January 2017

Provider News - February 2017

Provider News - March 2017

Provider News - May 2017

Provider News - June 2017

Provider News - August 2017

Provider News - November 2017