BlueSpeak September 2026: Provider Education

REQUIREMENTS: 1. By September 1, 2026: Providers must begin billing maternity E/M codes (99202-99499) with TH modifier for prenatal visits for patients expected to deliver on or after January 1, 2027. Update EHR templates and billing workflows to transition from global maternity billing (59425, 59426) to encounter-based billing. No rebilling of visits prior to 9/1/26 required. 2. By November 1, 2026: (a) Billing team must update system to require National Drug Codes (NDCs) and NDC units of measure in the 2410 loop for all CPT 96379 claims on 837P and 837I submissions. (b) Establish process to respond to Cotiviti requests for medical records within timeframe specified by Cotiviti for Post-Payment Clinical Claim Validation reviews. Ensure records are available for submission. 3. By January 1, 2027: All maternity claims must transition to individual E/M and delivery reporting instead of bundled global codes. Billing software must be configured to accept unbundled E/M codes with TH modifier for maternity services. Train billing staff on new coding requirements. 4. Ongoing - Immediately: (a) Educate all contracted providers that Blue KC members cannot be denied covered services because they refuse to participate in optional concierge programs. (b) Ensure front desk and clinical staff promote flu vaccination to high-risk members (chronic lung disease, heart disease, asthma, diabetes, hypertension, BMI ≥40, age 65+). 5. For Medicare Advantage plans: Verify correct coding for annual visits (IPPE G0402, AWV G0438, AWV Sub G0439) and append modifier 25 to E/M codes when billed together. Failure to comply with these updates will result in claim denials, payment delays, and potential compliance issues.