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[Georgia] Telehealth claims update: ICD-10-CM Excludes1 editing
Effective date
Sep 1, 2026
Identified
Jul 22, 2026
Summary
Effective September 1, 2026, Anthem Blue Cross Blue Shield (Georgia) will apply ICD-10-CM Excludes1 editing rules to telehealth claims billed with Place of Service 02 or 10, matching standards applied to other claim types. Claims with diagnosis code combinations prohibited by Excludes1 notes may be denied for reimbursement. Providers must verify diagnosis codes do not violate Excludes1 conventions before submission.
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What to do
Action · 8 steps
01Before September 1, 2026.
02Billing and clinical staff must review current ICD-10-CM Excludes1 notes and identify prohibited diagnosis code combinations commonly used in your telehealth services.
03Update billing software and claims submission protocols to flag or reject telehealth claims (POS 02 and POS 10) containing diagnosis code pairs that violate Excludes1 conventions.
04Providers must update documentation and coding workflows to ensure diagnosis codes submitted together on telehealth claims reflect accurate services and comply with Excludes1 rules.
05Train providers and coders on Excludes1 conventions specific to your specialty.
06Establish internal audit process to catch non-compliant code combinations before claim submission.
07Failure to comply will result in claim denials and delayed reimbursement.
08If disputes arise, submit electronically via Availity.com or in writing using the Provider Dispute Resolution Form with supporting documentation.
Codes mentioned
Z01.419Z12.4
Original notice
[Georgia] Telehealth claims update: ICD-10-CM Excludes1 editing
providernews.anthem.com · Always check the source before changing claims.
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