CommercialAdministrativeMedium impact
New Reconsideration Filing Limit for Commercial NICU Claims with Ineligible Reason Code of CR1, Effective Nov. 2, 2026
BCBS Montana·MT · Pediatrics, Critical Care·Reimbursement
Effective date
Nov 2, 2026
We identified it
Aug 1, 2026
Summary
Blue Cross Blue Shield of Montana is implementing a new 180-day filing deadline for reconsideration requests on commercial NICU claims with CR1 reason codes (level of care authorization mismatches). Billing teams must submit postservice medical necessity reviews within 180 days of claim finalization and include specific supporting documentation (itemized bill, admission/discharge summaries, and daily progress notes) or lose appeal rights.
Action Required
By November 2, 2026: Billing team must implement tracking system for commercial NICU claims assigned CR1 reason codes to monitor the 180-day reconsideration filing deadline from claim finalization date. Establish workflow to ensure all CR1 reconsideration requests include complete supporting documentation (itemized bill, admission summary, discharge summary, daily progress notes) before submission. Update internal appeal procedures and staff training materials to reflect the new deadline. Implement calendar alerts at 150 days post-finalization for any pending CR1 reconsiderations to prevent missed deadlines. Claims submitted after 180 days will not be reconsidered for postservice medical necessity review.