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We’ll Conduct coordination of Benefit Reviews for Medicaid Claims to Identify Potential Overlaps in Coverage
Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Jul 28, 2026
Summary
Effective November 1, 2026, Blue Cross and Blue Shield of Texas will conduct postpayment coordination of benefit (COB) reviews for Medicaid claims using Machinify to identify overlaps in coverage. If a claim was paid but another insurer is determined to be primary, BCBSTX will recover the overpayment. This affects claim adjudication processes and requires awareness of potential retroactive recovery actions.
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What to do
by Oct 31, 2026 · 5 steps
01Billing team must update internal processes to anticipate postpayment COB reviews and potential recovery notices from BCBSTX for Medicaid claims where secondary coverage exists.
02Implement tracking mechanism in billing system to flag Medicaid claims with potential dual coverage scenarios (spouse, employer-based, or other health plans).
03Train billing staff to promptly identify and document all secondary insurance information during patient intake and verification.
04Establish protocol to handle and reconcile payment recovery notices from BCBSTX/Machinify, including appeal procedures.
05Update patient collection processes to address potential patient liability adjustments if primary insurance pays differently than BCBSTX's secondary payment.
If missed: Failure to coordinate benefits information may result in claims being identified as overpayments with retroactive recovery actions by the plan.
Original notice
We’ll Conduct coordination of Benefit Reviews for Medicaid Claims to Identify Potential Overlaps in Coverage
bcbstx.com · Always check the source before changing claims.