Medicare AdvantageAdministrativeHigh impact
[New York] Service line limits update for Medicare Advantage claims
Anthem BCBS·NY·Medicare
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Anthem Blue Cross and Blue Shield Medicare Advantage plans in New York will no longer accept claims with more than 449 service lines (excluding the total charge line) per encounter. Billing teams must restructure high-volume claims by combining service lines, splitting by date of service, or submitting interim bills to ensure compliance.
Action Required
Effective immediately (as of June 24, 2026): Billing team must review and modify claim submission practices for all Anthem Medicare Advantage members in New York. (1) Audit current billing workflows to identify claims routinely exceeding 449 service lines per encounter; (2) Implement one or more mitigation strategies: combine service lines where clinically appropriate, split outpatient claims by date of service, or submit inpatient claims as interim bills; (3) Update billing system rules and provider training to enforce the 449 service line limit; (4) Train billing staff and providers on new claim submission requirements. Consequences: Claims exceeding 449 service lines will be rejected and not processed, resulting in claim denials and revenue cycle delays. Contact your Anthem provider representative with questions.