ProviderMatters

Payment Policy Updates (June 2026)

Posted on May 29, 2026

Health New England is committed to reviewing our internal procedures and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.

The following payment policies have been updated:

 

Payment Policy Revisions Effective Date Notes
Cardiac Services (PP065POL) – NEW August 2026
  • All Lines of Business
  • New Policy – Outlines what we do today and strengthening our Payment Policy Portfolio
Diagnostic Radiology (PP032POL) – NEW August 2026
  • All Lines of Business
  • New Policy – Outlines what we do today and strengthening our Payment Policy Portfolio
Inpatient Hospital Services (PP017POL)

60-Day Notification

 August 2026
  • ·Medicaid LOB
  • Aligned Medicaid requirement to match Medicare 3-day payment
Administrative Necessary Days (PP046POL) June 2026
  • All Lines of Business
  • Aligned language to strengthen Policy
Counseling and/or Risk Factor Reduction (PP042POL) June 2026
  • All Lines of Business
  • Aligned language to strengthen Policy
Diabetes Care (PP025POL)

Formerly “Diabetic Care”

 June 2026
  • All Lines of Business
  • Annual Review
  • Aligned title and authorization requirements
Mid-Level Practitioners (PP026POL) June 2026
  • All Lines of Business
  • Annual Review
  • Aligned language for clearer coding requirements
Unlisted Procedures (PP013POL) June 2026
  • All Lines of Business
  • Aligned language to strengthen Policy

 

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Categories: Provider Newsletter

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