The Michigan State Medical Society (MSMS) Health Care Delivery Department receives news from several of Michigan’s health plans and insurers related to policies, programs, and education opportunities. Below are some updates which may be of interest to physicians and other health care team members.
CMS News
CMS Launches New State Toolkit to Protect Children with Autism, Strengthen Oversight of Applied Behavior Analysis Services
The Centers for Medicare and Medicaid Services (CMS) released a new state toolkit designed to help states strengthen oversight of Applied Behavior Analysis (ABA) services provided to children with autism through Medicaid and the Children’s Health Insurance Program (CHIP). The resource emphasizes child-centered, evidence-based care while giving states tools to improve program integrity, provider oversight, service quality, and safeguards against inappropriate or unnecessary services. The toolkit supports states in ensuring children and families receive appropriate, high-quality behavioral health services while strengthening accountability within Medicaid and CHIP programs.
Regulatory Alignment for Predictable and Immediate Device Coverage Pathway (CMS-3487-NC) Procedural Notice Inviting Comment — August 7, 2026
The Centers for Medicare and Medicaid Services (CMS) issued a procedural notice inviting public comment on efforts to improve regulatory alignment for the Predictable and Immediate Device Coverage Pathway. The initiative focuses on creating a more predictable and efficient pathway for Medicare coverage of certain innovative medical devices, with the goal of improving coordination, reducing unnecessary delays, and helping beneficiaries gain timely access to new technologies. CMS is seeking stakeholder feedback to help inform the development and implementation of this approach.
CMS Press Release and Fact Sheet Summaries – find all press releases and fact sheets here: https://www.cms.gov/about-cms/contact/newsroom
New Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers (CMS-855B)
CMS released the new Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers (CMS-855B). Updates were also made to the Provider Enrollment, Chain, and Ownership System (PECOS) to mirror the paper application.
Medicare Administrative Contractors (MACs) began accepting the new application on June 1, 2026, and stopped accepting the old version on August 3, 2026.
Updates to the application include:
- Section verbiage and layout changes for improved clarity
- New section 4H Reassignment of Benefit Information
- Updated list of reportable adverse legal actions
- New submission reason of “You are solely enrolling in Medicare to participate in Medicaid or another health care program and will not bill Medicare”
McLaren Health Plan News
McLaren Health Plan Updates Provider Claim Adjustment Form
McLaren Health Plan has updated its Provider Claim Adjustment Form. The revised form is now available on the McLaren Health Plan website under Providers > Forms & Documents > Claim Adjustment Form.
Key filing deadlines include:
- Commercial, Health Advantage, Medicare Advantage and Medicare Supplement claims: Adjustment requests must be submitted within 90 days of an administrative action.
- Medicaid claims: Adjustment requests must be submitted within 90 days of an administrative action or 365 days from the date of service, whichever is later.
Providers should begin using the updated form for future claim adjustment requests. For questions, contact McLaren Health Plan Customer Service at 888-327-0671.
Modifier U4 Update
Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed. McLaren Health Plan aligns with MDHHS policy related to Intermittent Urinary Catheter reimbursement. As of January 1, 2026, modifier U4 is discontinued. The modifier was previously used to differentiate between hydrophilic coated intermittent urinary catheters from non-coated or other coated catheters for A4351 or A4532. Dates of services impacted are from January 1, 2026, to current. This will be a one-time recoupment project.
To ensure compliance with Medicaid guidelines, McLaren will be initiating a recovery of the impacted payments. The recovery process will begin on September 15, 2026.
Additional information regarding Medicaid guidelines can be found at:
MDHHS Bulletin MMP 25-51 Coverage Changes to Intermittent Urinary Catheters.
HAP News
PCP Assignment for PPO Members
Health Alliance Plan (HAP) PPO and Medicare Advantage PPO members may now have a primary care physician assigned to support better coordination of care. Primary Care Providers (PCP) may see these members listed on their member panel reports in the provider portal. Members may have selected their PCP directly or been attributed to a PCP based on previous claims history. The assignment does not limit access to care; any participating provider may treat a PPO member, even if that provider is not the PCP identified on the member’s record.
HAP’s New Online Prior Authorization Platform Launches August 25
HAP will launch Tapestry Link, powered by Epic, on August 25, 2026, replacing its current CareAffiliate online authorization application. Providers will continue to access the system by logging in at hap.org and selecting Authorizations, For Health Alliance Plan Members. The new platform offers easier navigation, in-application authorization requirement checks, fewer request types, simplified status searches and reduced questionnaires. Inpatient rehabilitation hospitals, long-term care hospitals, subacute rehabilitation facilities and skilled nursing facilities may use Tapestry Link to submit requests for HAP commercial members and Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs) and Dual Eligible Special Needs Plans (D-SNPs) members. Requests for other HAP Medicare Advantage members must continue to be submitted through Home and Community Care Transitions, formerly naviHealth. HAP will offer webinar training on August 20, 2026, from 4:00 – 5:00 pm and August 21, 2026, from 12:00 – 1:00 pm. Help guides and recordings will also be available through Tapestry Link and the HAP provider portal.
BCBSM/BCN News
Changes to maternity billing requirements to start Oct. 9, 2026
Changes to maternity billing requirements will take effect October 9, 2026, in advance of broader coding changes planned for January 1, 2027. The American Medical Association will discontinue global bundled-payment codes for prenatal, delivery and postpartum care and replace them with individual evaluation and management (E/M) or designated obstetric procedure codes. Practices that provide maternity care should review their billing workflows and prepare for the new requirements. Additional information is available in the August 2026 issue of The Record.
Register for Training About Prior Authorization Changes for Radiation Oncology, Therapeutic Radiopharmaceuticals
Radiation oncology services will be managed through the Oncology Value Management program, administered by OncoHealth, for dates of service on or after September. 1, 2026. The OncoHealth Provider Relations teams will host a series of webinars that will provide an overview of OncoHealth, an introduction to the Oncology Value Management program and information about what healthcare providers can expect from the program. Read more: August 2026 issue of The Record
For further questions or assistance, contact Dara J. Barrera, MSMS Director of Health Quality, Equity and Technology, at djbarrera@msms.org.