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

[New York] 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 deny reimbursement for all claims containing a Provider Preventable Condition (PPC) diagnosis code, specifically HAC01 (retention of a foreign object after surgery), including related services. The policy applies to professional and facility claims across multiple states. Providers are prohibited from balance billing members for denied claims under this policy.

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What to do

by Sep 30, 2026 · 6 steps
01Billing team must implement system controls to identify and flag claims containing HAC01 (retention of foreign object) and other Anthem-defined Provider Preventable Condition codes before submission.
02Update claim scrubbing software to prevent submission of claims with these diagnosis codes.
03Train all billing staff and providers on the never-event policy and prohibition against balance billing members.
04Establish internal audit procedures to review historical claims from October 1, 2026 forward, as Anthem reserves the right to recoup retroactively to the original October 1, 2026 effective date.
05Document all policy training and implementation steps.
06Contact Anthem for complete list of all defined PPC codes beyond HAC01.

Original notice

[New York] 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 →
[Ohio] Reimbursement policy reminder: Provider Preventable Conditions — Professional and FacilityHighEffective Oct 1, 2026 · Claims & Billing[Georgia] 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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