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OfficeLink Updates - June 2026 newsletter
Effective date
Sep 1, 2026
Identified
Sep 29, 2026
Summary
Aetna is implementing multiple billing and operational changes effective September 1, 2026, including new claim edits through the Claim and Code Review Program (CCRP) and a 15% payment reduction for certain radiology services billed with modifier CT. Additionally, commercial drug lists will be updated October 1, 2026, and providers must maintain current credentialing contact information to avoid removal from the directory.
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What to do
Action · 11 steps
01REQUIREMENTS:
By September 1, 2026: Billing team must monitor the Availity provider portal for new claim edits implemented by the Claim and Code Review Program (CCRP) for commercial, Medicare, and Student Health members.
02Update internal billing documentation to reflect these edits.
03Failure to comply with new edits may result in claim denials or delays.
04By September 1, 2026: Radiology billing staff must implement a 15% payment reduction for all radiology services billed with modifier CT to align with CMS reimbursement guidelines.
05Update billing system fee schedules and alert radiology providers of the payment reduction.
06Train coding staff to ensure proper modifier application.
07Before October 1, 2026: Pharmacy and billing teams must review updated commercial drug lists and communicate formulary changes to providers.
08Update pharmacy benefit information in billing systems and patient-facing materials.
09Non-compliance may result in claim rejections for non-formulary drugs.
10Immediately: Credentialing department must verify and update the practice's credentialing-specific email address with Aetna network representative or during next contract renewal.
11Front desk staff must confirm all provider profile information (name, address, phone, specialties) is current in the Availity Provider Data Management (PDM) tool.
If missed: Failure to maintain current information risks removal from Aetna provider directory.
Original notice
OfficeLink Updates - June 2026 newsletter
aetna.com · Always check the source before changing claims.