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BCBS New MexicoAll Plans · Administrative · Reimbursement · NM · Radiation Oncology, Gastroenterology, Infectious Disease +6 moreHigh impact

New Claims Editing Rules To Be Implemented in July 2026

Act
by Jul 15, 2026
Effective date
Jul 15, 2026
Identified
Jun 18, 2026

Summary

Blue Cross Blue Shield of New Mexico is implementing comprehensive claims editing rules in July 2026 that will automatically deny or rebundle claims with coding errors, affecting radiation therapy, STI testing, colonoscopies, hospital services, and many other procedures. Claims receiving edits will show ineligible reason codes starting with 'G'.

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What to do

by Jul 15, 2026 · 3 steps
01Billing team must update coding practices to align with new Lyric software edits including proper STI test code bundling (use 87801 for multiple tests instead of separate codes), avoid billing injection code 45381 with colonoscopy biopsies, ensure proper modifiers for anesthesia and bilateral procedures, limit J9299 units to 480 per 4 weeks, and verify diagnosis-procedure code matching for psoriasis treatments.
02Use Clear Claim Connection tool to test coding combinations before submission.
03Claims with errors will be denied with 'G' reason codes.

Codes mentioned

7730187491875918766187801J92994538145383453844538545388G6024969209692196922

Original notice

New Claims Editing Rules To Be Implemented in July 2026
bcbsnm.com · Always check the source before changing claims.
View original ↗

Related policy hubs

BCBS New Mexico policiesNM policy changesRadiation OncologyGastroenterologyInfectious DiseaseDermatologyNephrologyAnesthesiologyEmergency MedicineGeneral SurgeryOncologyCode 77301Code 87491Code 87591Code 87661Code 87801Code J9299Code 45381Code 45383Code 45384Code 45385Code 45388Code G6024Code 96920Code 96921Code 96922

Summaries are AI-assisted. Always confirm against the original payer notice.

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