Adaptive Maintenance for October 1, 2026

REQUIREMENTS: By October 1, 2026: - Billing team MUST enroll in Electronic Fund Transfer (EFT) through Blue Cross VT to ensure uninterrupted payment receipt. Paper checks will no longer be issued after this date. Sign up immediately at the provider portal or contact Provider Relations at (888) 449-0443, option 1. - All billing staff MUST review current NDC billing submissions and verify compliance with NDC, Unit of Measure, and Quantity requirements now to prevent future claim denials. By October 30, 2026: - Billing team MUST ensure all claim submissions comply with NDC billing rules. Claims processed on or after October 30, 2026 will have NDC rules systematically enforced; non-compliant claims will be DENIED, including claims previously accepted for the same services. - Review and correct any standing billing templates or claim submission processes that do not include proper NDC, Unit of Measure, and Quantity coding. Effective September 1, 2026 (for dates of service on or after): - Providers and billing staff MUST transition from global obstetric codes (59425, 59426) to new maternity services billing methodology: Use E/M codes appended with modifier -TH for first prenatal visit and all subsequent antepartum visits. Verify documentation supports medical decision making (MDM) or time per CPT guidelines. - Update encounter forms, EMR templates, and billing software to reflect new maternity coding requirements. - Ensure claims for prenatal care with dates of service PRIOR to September 1, 2026 continue using codes 59425 (4-6 visits) and 59426 (7+ visits) per global package rules. By November 1, 2026: - Billing team and clinical staff MUST review all updates to medical policies, provider handbook, preventive guide, and codes published by Blue Cross VT and implement changes in billing system, encounter forms, and clinical workflows. - For contraceptive counseling/management services: Ensure diagnosis codes in the first position align with eligible diagnoses listed in the preventive guide under "Preventive Gynecologic and Wellness Exam for Contraceptive Management" to ensure coverage without member cost-share. Ongoing: - Ensure all third-party billers and vendors are authorized with Blue Cross VT per provider handbook Section 6.1. Providers must maintain proof of business associate agreements and be prepared to provide proof upon request. - Maintain 180-day timely filing deadline for all claims or they will be denied. Verify claim receipt and status in Provider Resource Center at least 30 days after submission.