By February 16, 2026: Billing team must immediately update pre-authorization and claims review processes to enforce the new Excellus BlueCross BlueShield Hip Arthroplasty policy 7.01.96. SPECIFIC ACTIONS: (1) Update billing software validation rules to require documentation of Tönnis Grade 2-3 imaging for osteoarthritis cases via CPT 27130, 27132, 27134, 27137, 27140, 27145, 27146, 27147, 27156, 27157, 27161, 27162, 27163, 27164, 27165, 27167, 27175, 27176, 27177, 27178, 27179; (2) Create pre-authorization checklist requiring: imaging confirmation, 3-month function-limiting pain documentation (walking <0.25 mile or 2 city blocks), evidence of failed conservative management (physical therapy, medications, injections), or documented exception explaining why non-surgical management is inappropriate; (3) Add validation rule to DENY all total hip replacement claims for patients coded as dialysis-dependent (ICD-10: Z99.2); (4) Flag claims for revision hip procedures (CPT 27134-27138) to confirm post-operative complication documentation (dislocation, aseptic loosening, infection, fracture, instability, leg length discrepancy, osteolysis, elevated metal levels, or 6+ months unexplained pain unresponsive to non-surgical management); (5) Update encounter forms and provider templates to include exception documentation fields; (6) Train billing and authorization staff on Tönnis grading criteria and the 3 criteria exceptions. OWNERSHIP: Billing team (software updates and pre-auth), Providers (medical record documentation), Revenue Cycle Manager (staff training). CONSEQUENCE: Claims submitted without proper documentation or failing to meet medical necessity criteria will be denied, resulting in claim rejections and potential provider recredentialing issues.