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Anthem BCBSCommercial · Coverage · Claims & Billing · GA, CT, IN, KY, MO, NV, NH, NY, OH, WIHigh impact

[Georgia] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Jul 2, 2026

Summary

Effective October 1, 2026, Anthem will not reimburse professional provider and facility claims that include diagnosis codes for Provider Preventable Conditions (PPCs), specifically Hospital Acquired Conditions (HACs) including HAC01 (retention of foreign object after surgery). Providers are prohibited from balance billing members for non-reimbursed claims. The policy was originally announced with a delayed implementation; Anthem reserves the right to retroactively recoup payments to the originally announced effective date.

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What to do

by Sep 30, 2026 · 6 steps
01Billing team must implement system edits to identify and flag claims containing Never Event diagnosis codes and HAC01 codes before submission to Anthem.
02Update claim denial protocols and staff training to reflect non-reimbursement of these claims.
03Providers must stop balance billing members for denied claims related to this policy.
04Implement monitoring for retroactive recoupment activity from Anthem back to the originally announced effective date.
05Coordinate with clinical staff to ensure providers understand documentation requirements for indicating Provider Preventable Conditions using appropriate diagnosis codes.
06Review all pending and recently submitted claims for potential retroactive recoupment exposure.

Original notice

[Georgia] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[New York] Reimbursement policy reminder: Provider Preventable Conditions — Professional and FacilityHighEffective Oct 1, 2026 · Claims & Billing[Ohio] Reimbursement policy reminder: Provider Preventable Conditions — Professional and FacilityHighEffective Oct 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list

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