Reimbursement/Payment Policy policy updates
Track new and updated Reimbursement/Payment Policy policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Prior Authorization for Durable Medical Equipment (DME) | Blue Cross Blue Shield - Rhode Island | Reimbursement | Durable Medical Equipment (DME) | Modified | Oct 1, 2026 |
| Genomic Profiling for Selecting Targeted Cancer Therapies | Blue Cross Blue Shield - Rhode Island | Reimbursement | Genetic & Molecular Testing | Modified | Sep 1, 2026 |
| Device intensive procedure edit for outpatient facility claims | Blue Cross Blue Shield - Rhode Island | Reimbursement | — | Modified | Aug 15, 2026 |
| Autism Spectrum Disorders Mandate (Payment Policy) | Blue Cross Blue Shield - Rhode Island | Reimbursement | Psychiatry/Behavioral Health | Modified | Aug 1, 2026 |
| New Technology and CPT Codes for Medicare Advantage and Commercial Products | Blue Cross Blue Shield - Rhode Island | Reimbursement | Preventive Services & Screening | Modified | Jul 1, 2026 |
| Prior Authorization for Durable Medical Equipment (DME) | Blue Cross Blue Shield - Rhode Island | Reimbursement | Durable Medical Equipment (DME) | Modified | Jul 1, 2026 |
| Prior Authorization for Durable Medical Equipment (DME) | Blue Cross Blue Shield - Rhode Island | Reimbursement | Durable Medical Equipment (DME) | Modified | Jul 1, 2026 |
| Prior Authorization of Drugs | Blue Cross Blue Shield - Rhode Island | Reimbursement | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Retinal Telescreening for Diabetic Retinopathy | Blue Cross Blue Shield - Rhode Island | Reimbursement | Ophthalmology/Optometry | Modified | Jun 1, 2026 |
| Post service claims editing for certain medical/specialty drugs | Blue Cross Blue Shield - Rhode Island | Reimbursement | Pharmacy & Specialty Drugs | Modified | May 1, 2026 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.