2026 January Network Connection

REQUIREMENTS: 1. By December 31, 2025: Billing team must update all systems and member-facing materials to reflect CVS Pharmacy network removal. Stop processing prescriptions filled at CVS locations for Presbyterian Medicare members effective January 1, 2026. Update pharmacy network lists in billing software and deny any CVS claims submitted after the effective date. Direct patients to Costco Mail Order Pharmacy (1-800-607-6861) or other in-network pharmacies. 2. Effective immediately: Providers rendering services to Children in State Custody (CISC) must ensure all well-child visits are coded with diagnosis code Z62.21 (Child in Welfare Custody) alongside standard well-child procedure codes. Billing team must verify this code is included on all CISC claims. First visits must be coded as initial; subsequent visits as periodic screenings. 3. Immediately: Billing team must ensure claims for CISC well-child visits within 30 days of custody entry are processed and reimbursed outside standard visit schedules. Do not deny claims based on frequency limitations for CISC members. 4. Before March 20, 2026: Providers and billing staff must complete at least one Provider Education Conference & Webinar Series training event. This is a contractual requirement. Track attendance and maintain records for compliance. 5. Ongoing (every 90 days): Billing team responsible for verifying provider directory information is accurate in Presbyterian systems to ensure correct credentialing and network status. FAILURE TO COMPLY: CVS prescriptions filled after Jan 1, 2026 will not be covered for Presbyterian Medicare members. Missing Z62.21 diagnosis codes on CISC claims may result in denials or incorrect reimbursement. Failure to complete required training may affect provider contract status.