Quality, Clinical, and Medical Oversight Committee Approves Two New Policies

Please review these two new HealthTeam Advantage policies, both effective October 1, 2026. Use the links below to download each policy for future reference.

Medical Policy 10.0 – Tibial Nerve Stimulation for Bladder and Bowel Control

This health plan policy was created as there are no current Medicare local coverage determination/national coverage determination (LCD/NCD) guidelines to provide guidance related to applicable procedure codes. This policy addresses medical necessity for tibial nerve stimulation (TNS) in individuals with urinary retention, chronic urinary incontinence, and chronic fecal incontinence.

Tibial nerve stimulation works by sending small electrical pulses to a nerve near the ankle (the tibial nerve) that connects to the bladder. Treatment methods aim to improve symptoms by calming the nerves that control the bladder or bowel. Applicable procedure codes and criteria for approval are outlined in this policy to ensure providers are knowledgeable of criteria for approval prior to submission.

Download Medical Policy 10.0 PDF

General Policy 9.13 – Retrospective Authorization Request Policy

This policy was created to define retrospective prior authorizations and to ensure providers understand that retrospective prior authorizations must be submitted within 7 calendar days of the date of service. This policy also establishes guidelines for the submission and review of retrospective authorization requests and defines the appropriate post-service review processes for participating and non-participating providers.

Upon review of this policy, in-network providers and out-of-network providers will understand provider responsibilities and the appropriate steps for submission based on network status and claims submission.

Download General Policy 9.13 PDF