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BCBS MichiganCommercial · Administrative · Claims & Billing · MIHigh impact

Changes are coming to incident-to billing policy for Blue Cross, BCN commercial

Act
by Sep 1, 2026
Effective date
Sep 1, 2026
Identified
Jun 16, 2026

Summary

Blue Cross Blue Shield of Michigan and Blue Care Network are phasing out incident-to billing for commercial members. Starting September 1, 2026, incident-to claims must use modifier SA and won't receive value-based reimbursement. By March 1, 2027, eligible providers must bill under their own NPI or receive only 80% reimbursement.

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What to do

by Sep 1, 2026 · 4 steps
01Billing team must add modifier SA to all incident-to claims for Blue Cross/BCN commercial members.
02Update billing system to flag these claims as ineligible for value-based reimbursement.
03By February 28, 2027: Eligible providers (physicians, nurse practitioners, physician assistants) must enroll with Blue Cross/BCN to obtain their own NPI for direct billing.
04By March 1, 2027: All eligible providers must bill under their own NPI - continued incident-to billing will result in 20% payment reduction and loss of value-based reimbursement eligibility.

Original notice

Changes are coming to incident-to billing policy for Blue Cross, BCN commercial
bcbsm.com · Always check the source before changing claims.
View original ↗

Related changes

See all BCBS Michigan changes →
Use modifier SA on incident-to claims, starting Sept. 1HighEffective Sep 1, 2026 · CodingBrowse every BCBS Michigan change in the policy list

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