CommercialDocumentationHigh impact
[Georgia] Review Excludes1 Notes to help keep claims on track
Anthem BCBS·GA·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
Effective October 1, 2026, Anthem Blue Cross and Blue Shield in Georgia will implement enhanced Excludes1 claim editing to enforce ICD-10-CM coding standards. Billing teams must review Excludes1 Notes before submitting claims to prevent diagnosis code combinations that violate coding guidelines. Claims rejected for Excludes1 violations require either corrected submissions with appropriate codes or disputes supported by ICD-10-CM documentation.
Action Required
By September 30, 2026: Billing team must implement the following: (1) Review and update internal coding verification procedures to include Excludes1 Notes validation before claim submission; (2) Train all coding and billing staff on ICD-10-CM Excludes1 guidelines, emphasizing category-level notes (first three characters) apply to all codes within that category and specific code-level notes apply only to individual codes; (3) Establish a pre-submission quality check process to identify conflicting diagnosis codes before claims are sent to Anthem; (4) Document the dispute process workflow in billing system, noting that claims rejected for Excludes1 violations can be corrected via corrected claim submission or dispute via Availity portal (https://Availity.com under Claims & Payments section); (5) Brief providers on proper diagnosis code selection and the requirement that supporting ICD-10-CM documentation must accompany any disputes. Failure to comply will result in claim denials and rework, increasing accounts receivable delays and administrative burden.