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AB2026-06-001 Updates and new information
Effective date
Jul 1, 2026
Identified
Jun 20, 2026
Summary
Capital Blue Cross will reject claims submitted to Capital that should have been submitted to the member's home plan, effective August 1, 2026, using claim rejection code C1167I. Beginning July 1, 2026, EviCore laboratory medical policies apply to outpatient laboratory services for all provider types, and laboratory services that do not meet the applicable criteria will be considered non-covered. Several procedure codes no longer require preauthorization for Commercial and Medicare Advantage effective July 1, 2026, and closed-claim letters move from USPS mail to a weekly electronic eCLD file effective August 1, 2026.
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What to do
Action · 13 steps
01Already effective July 1, 2026: Billing team and providers must comply with the EviCore medical policy criteria for outpatient laboratory services, including independent laboratories, physician office laboratories and hospital-based laboratories.
02Verify member eligibility and benefits before rendering services.
03Review EviCore clinical guidelines and associated CPT codes through the link on Capital's medical policies page at Capbluecross.com.
04Check the Single source preauthorization list for the codes listed in the July 1, 2026 update, since they no longer require preauthorization for Commercial and Medicare Advantage.
05Already effective July 1, 2026: For drug testing in pain management and substance abuse treatment, use FP-01.007, which replaces NR-30.023 (retired June 30, 2026) for professional and facility services under Commercial, CHIP and FEP.
06Already effective August 1, 2026: Claims submitted to Capital that should have been submitted to the member's home plan will be rejected with code C1167I and the reason 'Submit Claim to Member's Home Plan'.
07Contact Provider Automation with questions.
08Already effective August 1, 2026: Closed-claim letters are replaced by a weekly Electronic Closed Letter Detail (eCLD) file, which is accessed through Availity Essentials under Capital Payer Space Secure File Transfer (SFT).
09Ensure staff have access to Availity Essentials and identify the staff responsible for reviewing electronic claim files.
10Already effective January 1, 2026 for CHIP members with a blood lead level of 3.5 mcg/dL and higher: Complete the AET Environmental Lead Investigation Referral Form, found on Availity Essentials under Resources > Provider Forms, with one form for all children residing in the same household, submitted only once and including relevant clinical notes.
11Send it to AET by fax at 610.891.0559 or by email to m.mcerlean@aetinc.us.
12AET may submit claims using procedure code T1029 with the appropriate primary diagnosis code for abnormal lead levels or lead exposure, and Capital will cover the investigation at no cost share to the CHIP member.
13For questions about the form or process, call AET at 1.800.969.6238.
Codes mentioned
T1029814128144388240
Original notice
AB2026-06-001 Updates and new information
capbluecross.com · Always check the source before changing claims.