Medicare AdvantageAdministrativeMedium impact
[Georgia] Reminder: Ensure billed charges and units are accurate on professional claims
Anthem BCBS·GA·Provider Bulletin
Effective date
Jul 17, 2026
We identified it
May 16, 2026
Summary
Effective July 17, 2026, Anthem will implement validation edits on professional claims to identify potentially erroneous billed charges and units. Claims with values exceeding system thresholds will be rejected pre-adjudication with specific response codes (A7:21, A7:583, A7:476). Billing teams must review and correct claims with inaccurate charges or units before resubmission.
Action Required
By July 17, 2026: Billing team must implement internal controls to validate billed charges (SV102) and units/quantity (SV103, SV104) against submitted procedure codes (SV101-2) on all professional claims before submission to Anthem. Establish a review process to catch unusually high charges or units per line item. When claims are rejected with error message 'Charges or Units exceed the standard values for the billed services' or response codes A7:21, A7:583, A7:476, immediately review the submitted claim for data entry errors, correct inaccuracies, and resubmit. Train billing staff on the new validation requirements and establish a process to monitor 277CA transaction responses and Availity Essentials reports for these rejection codes. This applies to dates of service on or after July 17, 2026. Failure to correct errors will result in claim rejections and delayed payment.