Updates

Policy changes, revisions, and newly published standards. Licensed members receive continuous updates.

1. 2026-06-18

   Updated

   · Medicare

   Medicare — Submission Standard revised for 2026 MPFS

   Refreshed fee schedule references and NCCI edit examples.

2. 2026-06-11

   New

   · Authorization

   Authorization workflow — retro auth pathway added

   New decision tree for retroactive authorization requests.

3. 2026-06-02

   Policy Change

   · Behavioral Health

   Behavioral Health medical necessity guidance

   Aligned with updated commercial payer BH criteria.

4. 2026-05-30

   Updated

   · ASC Billing

   ASC Billing — device-intensive procedure reference

   Added device credit and offset reference card.

5. 2026-05-21

   Updated

   · Denial Prevention

   Denial Prevention — CO-97 bundling controls

   Expanded NCCI PTP edit prevention checklist.

6. 2026-05-12

   New

   · Provider Enrollment

   Provider Enrollment — PECOS revalidation cadence

   New checklist for revalidation tracking.

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