CommercialCoverageHigh impact
Medical and Clinical Policy Updates - Effective June 1, 2026
Sentara Health Plans·General Surgery, Urology, Neurology +5 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Mar 5, 2026
Summary
Sentara Health Plans has updated 27 medical policies effective June 1, 2026, including revisions to varicose vein treatment, spinal pain management procedures, electrical stimulation, non-oncology embolization, benign prostatic hyperplasia treatment, and ophthalmic procedures. Additionally, 7 policies have been archived and removed from coverage, including endometrial ablation, left atrial appendage occlusion, and vestibular testing. Billing teams must immediately review affected policies to determine which require prior authorization updates and which procedures are no longer covered.
Action Required
By May 31, 2026: Billing team must complete the following: (1) Access sentarahealthplans.com and pal.sentarahealthplans.com to review the full text of all 27 revised, reviewed, and archived policies listed in this update; (2) Cross-reference each revised policy against current billing system rules to identify any changes to prior authorization requirements, medical necessity criteria, or covered procedure codes; (3) Update the Prior Authorization List in billing software for all REVISED policies (Surgical 04, 119, 235, 83, 60; Medical 349) to reflect new requirements; (4) Remove all ARCHIVED policies from the system to prevent billing and ensure claims denials do not occur for non-covered services (Surgical 15, 19, 102; Medical 262, 174; DME 267); (5) Update provider encounter forms and billing templates to reflect coverage changes; (6) Communicate with providers regarding archived procedures to prevent unnecessary claim submissions. Failure to implement these changes will result in claim denials for archived procedures and improper authorization for revised procedures.