Reimbursement Policy Updates

REQUIREMENTS: - By December 4, 2026: Billing team must access and review all updated reimbursement policies in Availity Essentials through the Plan Documents Viewer application (available in Payer Spaces for Blue Cross and Blue Shield of Montana). - Before each policy effective date, update billing system rules and fee schedules to reflect new reimbursement methodologies for affected procedure codes: • Chiropractic Care Services (effective July 24, 2026 - PAST) • Clinical Laboratory Reimbursement Policy (effective Aug. 18, 2026 - PAST) • Modifier Reimbursement and Reference Policy (effective Oct. 19, 2026 - PAST) • Non-Reimbursable EIU Services/Codes (effective Aug. 15, 2026 - PAST) • RBRVS and Anesthesia Conversion Factor (effective Aug. 1, 2026 - PAST) • Robotic Assisted Surgery (effective Aug. 4, 2026 - PAST) • Trauma Activation - Facility Services (effective Aug. 14, 2026 - PAST) • Laboratory-specific panels (effective Dec. 4, 2026): Diabetes Mellitus Testing, Prenatal Screening, Oral Cancer Screening, Pathogen Panel, Biomarkers for MI/CHF, Inflammation Testing, Urine Culture, GGT Testing, Coronavirus Testing, Alpha-1 Antitrypsin Testing, Nucleic Acid Probe Identification, Colorectal Cancer Screening - Providers must submit claims using the most appropriate codes based on updated policies and medical record documentation. - Failure to update billing systems may result in claim denials or incorrect reimbursement rates.