Watch for New Edge Benefit Plan Members in 2027

By December 31, 2026: (1) Front desk staff must request member ID cards at check-in for all patients and verify Edge plan membership. (2) Billing team must train on new Edge plan ID card format, which displays multiple copay options for office and specialist visits. (3) Before each appointment, use Availity Essentials or preferred vendor to verify current copay amount and prior authorization requirements for the specific benefit plan tier. (4) Ensure billing system is updated to capture and include the rendering provider's NPI on all claim submissions for Edge members. (5) Update encounter forms and staff training materials to reflect that Edge members have no coinsurance and no deductibles for in-network covered services. Failure to collect correct copays and verify coverage may result in claim denials and patient payment disputes.