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New Claims Editing Rules To Be Implemented in July 2026
BCBS New Mexico·NM · Radiation Oncology, Gastroenterology, Infectious Disease +6 more·Reimbursement
Effective date
Jul 15, 2026
We identified it
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'.
Action Required
By July 15, 2026: Billing 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. Use Clear Claim Connection tool to test coding combinations before submission. Claims with errors will be denied with 'G' reason codes.