CommercialAdministrativeMedium impact
[New York] Reminder: Ensure billed charges and units are accurate on professional claims
Anthem BCBS·NY·Provider Bulletin
Effective date
Jul 17, 2026
We identified it
May 16, 2026
Summary
Anthem will implement automated validation edits on professional claims beginning July 17, 2026 to reject claims with unusually high charges or units that may indicate data entry errors. Claims exceeding system thresholds will be rejected prior to adjudication with specific error codes (A7:21, A7:583, A7:476), requiring providers to review, correct, and resubmit.
Action Required
By July 17, 2026: Billing team must implement internal validation procedures to review all professional claims before submission, focusing on line-item charge amounts (SV102) and units/quantity (SV103/SV104) to ensure they align with billed procedure codes (SV101-2). Establish a process to identify and correct claims that may exceed Anthem's validation thresholds before submission to avoid rejections. Train billing staff to recognize error codes A7:21, A7:583, and A7:476 in 277CA transactions and the error message 'Charges or Units exceed the standard values for the billed services' in Availity reports. When rejections occur, verify accuracy of units and charges against services provided, correct any errors, and resubmit. Failure to address this will result in claim rejections and delays in payment processing.