High impact
Payment Policy Updates
CareFirst BlueCross BlueShield·Effective Jul 1, 2026
CareFirst has expanded three existing Commercial payment policies (Claims During Inpatient Admission, MPPR Well Problem Visit E/M Pay Percent, and Outpatient Services Prior to Admission) to Government Programs lines of business effective October 1, 2026. Additionally, a new diagnosis coding policy (PP GP 002.01) will take effect for Government Programs, and four Commercial policies received clarifications effective July 1, 2026. The policy emphasizes denial criteria for inappropriate multi-unit billing, modifier 59/91 misuse, ICD-10 coding violations, laterality conflicts, and secondary-only diagnosis codes used as primary.