All PlansAdministrativeLow impact
Payment Policy Updates
CareFirst BlueCross BlueShield·Reimbursement
Effective date
May 1, 2026
We identified it
Sep 3, 2026
Summary
CareFirst issued three clarifying policy updates effective May 1, 2026: modifier 25 language was removed from PP CO 600.05, coding validation examples were added to PP CO 002.02 without logic changes, and consultation services policy PP CO 014.02 now includes cross-reference to PP CO 010.01. Additionally, CareFirst is investigating an issue where some providers received paper checks instead of ACH/EFT payments since May 10; no provider action is needed pending resolution.
Action Required
Billing team should review the updated policies PP CO 600.05 (Modifiers), PP CO 002.02 (Coding Validation), and PP CO 014.02 (Consultation Services) in CareFirst's online Payment Policy Reference Manual to familiarize staff with clarified language and examples. No immediate workflow changes are required as these updates do not alter existing logic or validation rules. Monitor CareFirst communications for updates regarding the EFT payment issue; no action is required at this time, but verify that payments are being received in the expected format (ACH/EFT vs. check).