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Two New Claims Editing Rules To Be Implemented in July 2026
BCBS New Mexico·NM · Orthopedics, Ophthalmology, General Surgery·Reimbursement
Effective date
Jul 8, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of New Mexico will implement two new claims editing rules in July 2026: a Laterality Diagnosis Check that will deny claims with inconsistent modifiers (LT/RT/50) and diagnoses, and a Revenue Code and Procedure rule that validates HCPCS codes with implant revenue codes 275, 276, and 278. Claims receiving these edits will show ineligible reason codes with an alpha character 'G'.
Action Required
By July 8, 2026: Billing team must verify all claims with laterality modifiers (LT, RT, 50) match corresponding diagnoses before submission. For outpatient facility claims, ensure HCPCS codes align with implant revenue codes 275, 276, or 278. Use Clear Claim Connection (C3) software to pre-validate coding combinations. Update billing system to flag potential 'G' reason code denials for these editing rules.