CommercialCoverageHigh impact
Preventive Health Services
Blue Cross & Blue Shield of Mississippi·MS · Family Medicine, Internal Medicine, Pediatrics +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross & Blue Shield of Mississippi updated their preventive health services policy to align with PPACA requirements, covering preventive services at 100% with no cost-sharing when provided by network providers. The policy specifies that Cologuard testing requires cost-sharing since it's provided by a non-network provider, and services billed outside preventive guidelines will be denied.
Action Required
Immediately: Billing team must verify all preventive services listed in this policy are billed with appropriate ICD-10 codes for pregnant women, newborns, children 0-21, women 21+, and high-risk populations 21+. Update billing system to flag Cologuard tests as requiring patient cost-sharing due to non-network provider status. Ensure all asterisk-marked services have documented risk factors to support medical necessity, or claims will be denied as not medically necessary.