← Back to list
Reminder: We’ll Conduct Postpayment Reviews on Medicaid Claims
Act
by Oct 2, 2026
Effective date
Oct 2, 2026
Identified
Oct 2, 2026
Summary
Beginning October 2, 2026, Medicaid will conduct postpayment reviews of claims to identify billing inconsistencies, coding errors, and reimbursement policy misalignment. Reviews will examine current claims, historical claims from January 1, 2026 onward, and prospective claims. Based on findings, the payer may request refunds or apply adjustments to future payments.
Get alerts when payers change rules like this one
We check BCBS Texas and other payers every day and email you when a change matches your specialty and state.
Get BCBS Texas alertsPolicy Monitoring is free. No card required.
What to do
by Oct 2, 2026 · 7 steps
01Billing team must prepare for Medicaid postpayment audits by.
02Reviewing all claims submitted since January 1, 2026 for coding accuracy and documentation completeness.
03Auditing billing practices against Medicaid and CMS provider guidelines and professional coding standards.
04Ensuring all claim documentation supports the billed services and diagnoses.
05Designating a team member to monitor for formal audit notifications from the payer.
06Before October 21, 2026: Providers and billing staff should attend one of the three scheduled webinars (Oct 21, 10-11am; Oct 22, 10-11am; or Oct 22, 1-2pm) to understand the postpayment review process and requirements.
07Upon receipt of audit findings: Review notification carefully, gather supporting documentation for any questioned claims, and determine if refund is warranted or if reconsideration options should be pursued.
If missed: Failure to maintain compliant documentation may result in claim denials, payment recoupments, or adjustments to future reimbursement.
Original notice
Reminder: We’ll Conduct Postpayment Reviews on Medicaid Claims
bcbstx.com · Always check the source before changing claims.