All PlansAdministrativeHigh impact
AB2026-05-005 Reminders
Capital Blue Cross·Provider News
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross issued a comprehensive administrative bulletin with multiple policy updates including provider data attestation requirements, MUE claims editing enhancements, expanded breast cancer screening coverage including biopsies, CAQH attestation reminders, and hemophilia factor billing system updates.
Action Required
Immediately: Review and attest provider demographic data every 90 days using Capital Blue Cross Provider/Facility Maintenance tools (NOT Availity's Provider Data Management). Update billing software to handle MUE limits correctly - split claim lines when units exceed MUE values and apply appropriate modifiers (76, 77, 91, RT, LT) for MAI 1 codes. By June 1, 2026: Update claims editing system for hemophilia factor products to ensure quantity billed reflects accurate international units/milligrams/micrograms and split lines when exceeding 9,999 unit maximum. Begin billing breast cancer biopsies as preventive services when part of initial screening. Maintain CAQH attestation every 120 days to avoid credentialing delays.