CommercialDocumentationMedium impact
AB2026-05-003 Quality information
Capital Blue Cross·Family Medicine, Internal Medicine, General Practice +2 more·Provider News
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
This administrative bulletin provides updated quality measure guidelines for breast cancer screening, cervical cancer screening, depression screening, and follow-up care for multiple chronic conditions. It emphasizes best practices for documentation, proper use of exclusion codes, and utilization of the Theon system for gap reporting and data submissions.
Action Required
By May 1, 2026: Providers must ensure proper documentation of standardized depression screening tools (PHQ-9, PHQ-2) in medical records with positive/negative results. For positive screens, document follow-up plans within 2 days including referrals, medications, or interventions. Billing teams should verify proper ICD-10 coding for mastectomy exclusions and hysterectomy exclusions. All staff should utilize Theon system for open gap reports and supplemental data submissions for quality measures.