Healthcare reimbursement and compliance requirements continue to evolve.
Here are the key updates physician practices should be watching this month.

 BCBSTX E/M Review Changes Effective July 1

BCBSTX will begin reviewing office, inpatient, and outpatient E/M claims for commercial plans beginning July 1, 2026. Claims that do not meet the insurer’s documentation requirements may be reimbursed at a lower E/M level.

Practices should review documentation workflows, verify coding accuracy, and monitor remittance advice for potential down coded claims.

 Review the changes before the July 1 effective date →

 Molina Reminder: AI Voice Technology Prohibited for Provider Calls

Molina Healthcare recently reminded providers that AI-generated voice technology is prohibited for certain payer communications, including billing, eligibility verification, and prior authorizations. As AI adoption grows, practices should review payer requirements before implementing automated voice solutions.

At Peregrine Healthcare, all payer communications are conducted by experienced professionals, not AI voice systems.

 Noridian JF Updates Anesthesia Billing Guidance for Pain Procedures

In a May 28, 2026 update, Noridian Jurisdiction F Medicare Part B reinforced that moderate sedation, Monitored Anesthesia Care (MAC), and general anesthesia are rarely medically necessary for many routine interventional pain procedures. Pain management practices should review documentation standards, anesthesia utilization patterns, and denial trends to help reduce reimbursement risk.

 Could your anesthesia billing be at risk? Read the full update →

Noridian Highlights Common Injection Billing Errors

Noridian recently identified recurring billing issues involving hyaluronic acid knee injections, including incorrect units, modifier misuse, coding errors, and insufficient documentation. Reviewing billing and documentation processes can help reduce denials and payment delays.

See the common mistakes and recommended action steps →

CAQH Becomes DataSpring

CAQH has officially rebranded as DataSpring and transitioned to a new ownership structure led by some of the nation’s largest health plans. The newly announced Board of Directors includes leaders from UnitedHealthcare, Aetna, Cigna, Humana, Elevance Health, Centene, and Horizon Blue Cross Blue Shield of New Jersey.

Why it matters: DataSpring remains a central source for provider credentialing, enrollment, and directory data, making accurate provider information more important than ever.

 Learn what this change could mean for providers, credentialing, and practice operations →

Ask Peregrine

Q: A recent client asked us whether they should wait for the final HIPAA Security Rule updates before reviewing their cybersecurity and IT infrastructure.

A:  Our recommendation is no. While HHS has not yet released the final rule, the proposed updates reinforce the growing importance of cybersecurity, risk management, vendor oversight, and protecting patient data.

Now is a good time to evaluate your cybersecurity readiness, security protocols, and IT support structure. Technology issues and cybersecurity threats can affect operations, revenue cycle performance, and HIPAA compliance regardless of when the final rule is released.

Want to learn more? Read our latest blog on why experienced healthcare IT support matters and how the right technology partner can help practices stay prepared.

Stay Connected Between Issues

The Pulse delivers the highlights each month, but we share important payer, compliance, credentialing, and reimbursement updates all month long. Follow Peregrine Healthcare on Facebook, LinkedIn, and Instagram to stay informed.