Payer Updates | May 2026
For a curated summary of the latest payer updates* impacting Northern Michigan provider offices, grouped by payer, please see below:
BCBSM and BCN
Change in prior authorization process for noncovered services for Medicare Advantage members only. SOURCE
Humana
Humana No Longer Allowing Retro Authorizations When Submitted Post Service (Effective May 1): Below, is an article from Humana regarding this change. The work around is to submit a claim for denial, with no authorization. Then, file an appeal when the claim denial is received. Munson is advocating to have this program revoked.
Ensuring compliance: Timely authorization request submission for select services, PA is needed before care is fully furnished. Per the Centers for Medicare & Medicaid Services (CMS), requests after services are fully furnished must be processed as payment requests. After services are fully furnished, please submit a claim instead of a request for authorization (retro authorization). Claims may be denied if an authorization was required and not obtained. Consult the PAL and Provider Manual for guidance.
Priority Health
Epic Launch Planned for This Summer: In future newsletters, we’ll share updates on Epic go-live planning and activities. All Priority Health operational functions will transition from Facets to Epic as a part of this large-scale project.
*News items from the following payers were reviewed for this month’s highlighted articles: Aetna, BCBSM, Blue Care Complete, Blue Care Network (BCN), Health Alliance, McLaren, Molina, Nomi Health, and Priority Health.