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AB2026-10-001 Updates and new information
Effective date
Jan 1, 2027
Identified
Oct 1, 2026
Summary
Capital Blue Cross is implementing multiple operational and reimbursement changes effective January 1, 2027, including discontinuation of four behavioral health and surgical supply codes (G0674, G0675, G0678, A4550, A4649), a mandatory transition to ProAuth for all preauthorization requests by December 1, 2026 (phasing out phone/fax), a switch from Equian/Optum to Machinify for itemized bill reviews on December 1, 2026, and a new room and board unbundling policy (FR-02.005) requiring facility providers to bundle certain services into facility fees rather than bill separately.
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What to do
Action · 21 steps
01IMMEDIATE ACTIONS REQUIRED - Multiple deadlines:
By December 1, 2026.
02Billing team must transition ALL preauthorization submissions to ProAuth tool in Availity Essentials.
03Stop accepting phone and fax submissions except for documented portal issues (with Availity ticket) or NICU cases per PA Act 81.
04Update internal workflows and provider communication templates.
05Facility providers must prepare for Machinify IBR vendor transition.
06Ensure all staff are aware, update contact information (email/fax) in Machinify system, and train staff on new portal.
07Attend one of three Microsoft Teams training sessions (Dec 1 10AM-11AM EST, Dec 1 2PM-3PM EST, or Dec 3 11AM-12PM EST).
08When submitting preauthorization for multiple services, billing team must include ALL applicable CPT codes as separate lines at submission - codes in clinical documentation or attachments alone will NOT be reviewed.
09By January 1, 2027.
10Billing team must remove codes G0674, G0675, G0678, A4550, and A4649 from billing system for Commercial and Medicare Advantage plans.
11Configure system to deny or block submission of these codes.
12Facility providers must implement new room and board unbundling policy FR-02.005.
13Audit current billing practices and stop separately billing supplies, equipment, and routine facility expenses that must be bundled into facility/room and board charges.
14Update charge description masters (CDM) and billing rules.
15All providers must complete required attestations and demographic updates: Capital's Portal (Attest every 90 days, Update within 30 days of change), CAQH ProView (Attest every 120 days, Update within 30 days), and NPPES (Update within 30 days).
16Use newly released Quick Reference Guides from Provider Hub.
17CONSEQUENCES: Claims for discontinued codes will be denied.
18Preauthorization requests submitted via phone/fax after Dec 1 will not be accepted.
19CPT codes not entered as separate authorization lines will not be reviewed or authorized.
20Failure to bundle per FR-02.005 may result in claim denials and itemized bill reviews.
21Attestation failures may impact provider directory accuracy and regulatory compliance.
Codes mentioned
G0674G0675G0678A4550A4649
Original notice
AB2026-10-001 Updates and new information
capbluecross.com · Always check the source before changing claims.