News & Media
Reimbursement Advocacy Alert: CGM Coverage and Payer Policy Updates
Blue Cross Blue Shield – Changes for continuous glucose monitors (CGM) for commercial members Health Maintenance Organization (HMO)/Preferred Provider Organization (PPO)
Effective January, 1, 2026, Blue Cross Blue Shield of Michigan and Blue Care Network are changing how they cover continuous glucose monitor products filled at a pharmacy or through a durable medical equipment provider. Read more: December 2025 issue of The Record
Blue Cross Blue Shield - Changes to prior authorization requirements for select services HMO/Medicare Advantage Preferred Provider Organization (MAPPO)/Medicare Advantage Health Maintenance Organization (MAHMO)
Blue Cross and Blue Care Network changed prior authorization requirements for some services for Medicare Plus BlueSM, Blue Care Network commercial and Blue Care Network AdvantageSM members on November 2, 2025. Read more: December 2025 issue of The Record
Blue Cross Blue Shield: Be sure to include physician National Provider Identification (NPI) number when submitting Medicare Advantage PPO claims MAPPO
All claims for Medicare-covered services and items must include the National Provider Identification number of the ordering or referring physician to avoid unnecessary delays or denials. Read more: December 2025 issue of The Record
Health Alliance Plan (HAP) New Online Prior Authorization Platform Coming in 2026 – Users Need to Verify Identity
To better support the Centers for Medicare & Medicaid Services interoperability requirements, Tapestry Link, powered by Epic, will replace their current online authorizations application, CareAffiliate. The expected go-live is spring 2026. Tapestry Link requires an extra level of security to verify user identity. Physicians will need to provide your date of birth and gender. If a practice does not need access to request prior authorizations, that option can be selected. Please continue to watch the Health Alliance Plan provider newsroom for updates regarding Tapestry Link.
HAP Anesthesia and Interventional Pain Management Guidelines Updated in the HAP Provider Manual
The anesthesia and pain management sections in the Health Alliance Plan Provider Manual have been separated into two different sections with updated content as outlined below. This updated content is effective February 1, 2026.
Section 11 - Anesthesia Reimbursement Policy
This section was updated to remove all interventional pain management requirements and instead is a comprehensive, anesthesia-only policy with:
- Expanded methodology
- Modifier rules
- Place of service guidance
- Compliance structure
Section 12 Interventional Pain Management Policy
The updated content is now a standalone interventional pain management policy that removes anesthesia specific coding, methodology, regulations, etc. It includes specific interventional pain management:
- Requirements
- Prior authorization rules
- Place of service clarification
- Provider eligibility requirements
Medicare Participation for Calendar Year 2026
The open enrollment period for Medicare participation during calendar year (CY) 2026 extends through December 31, 2025. Physicians, practitioners, and suppliers must make their Medicare participation decision for CY 2026 by December 31, 2025. Providers who want to maintain their current participation status, participating or non-participating, do not need to take any action during this annual participation enrollment program. Read more here: 2026 CMS Participation Announcement
Updates to Telehealth for Calendar Year 2026
On November 14, 2025, CMS updated Telehealth FAQ Calendar Year 2026 to reflect a new effective date for the in-person non-telehealth visit requirement. This requirement is effective after January 30, 2026.