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BCBS MontanaAll Plans · Billing Codes · Reimbursement · MT · Radiation Oncology, Gastroenterology, Oncology +5 moreHigh impact

New Claims Editing Rules To Be Implemented in July 2026

Act
by Jul 15, 2026
Effective date
Jul 15, 2026
Identified
Jun 18, 2026

Summary

Blue Cross Blue Shield of Montana is implementing 18 new automated claims editing rules in their Lyric software database effective July 15, 2026. These rules will automatically deny or rebundle claims that don't meet specific coding requirements, with denials showing reason codes beginning with 'G'.

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What to do

by Jul 15, 2026 · 4 steps
01Billing team must review and update billing practices for all affected codes to prevent automatic claim denials.
02Key actions: 1) Ensure CPT 77301 is billed within 30 days of radiation therapy codes, 2) Bundle STI testing codes (87491, 87591, 87661) into comprehensive code 87801 when appropriate, 3) Limit J9299 (Nivolumab) to maximum 480 units per 4 weeks, 4) Stop billing injection code 45381 with colonoscopy biopsy/polypectomy procedures, 5) Add modifier 54 for ER surgical procedures without follow-up care, 6) Verify appropriate modifiers for anesthesia and bilateral procedures, 7) Ensure primary diagnoses are not administrative or social determinant codes.
03Update billing software rules and staff training.
04Claims not meeting these criteria will be automatically denied.

Codes mentioned

7730187491875918766187801J92994538145383453844538545388G6024969209692196922

Original notice

New Claims Editing Rules To Be Implemented in July 2026
bcbsmt.com · Always check the source before changing claims.
View original ↗

Related policy hubs

BCBS Montana policiesMT policy changesRadiation OncologyGastroenterologyOncologyAnesthesiologyGeneral SurgeryEmergency MedicineDermatologyNephrologyCode 77301Code 87491Code 87591Code 87661Code 87801Code J9299Code 45381Code 45383Code 45384Code 45385Code 45388Code G6024Code 96920Code 96921Code 96922

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