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BCBS IllinoisMedicaid · Administrative · ReimbursementHigh impact

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, the payer will conduct postpayment reviews of Medicaid member claims to identify billing inconsistencies, coding errors, and reimbursement policy alignment issues. Reviews will apply to claims paid on or after January 1, 2026, current claims, and prospective claims. The payer may request refunds or adjust future payments based on findings if documentation does not support submitted claims.

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What to do

by Oct 2, 2026 · 7 steps
01Billing team must prepare for postpayment audits by.
02Auditing all Medicaid claims paid since January 1, 2026, for coding accuracy, medical necessity documentation, and reimbursement policy compliance.
03Ensuring complete, legible documentation is maintained in patient records to support all submitted claims.
04Reviewing internal billing practices against Medicaid and CMS provider guidelines and professional coding standards.
05Designating a staff member to track and respond to postpayment review notifications from the payer.
06Strongly recommended: Providers should register for the limited webinar series (October 26, 29, or 30, 2026) to understand the specific postpayment review process and edit rules.
07Consequences of inaction: Claims determined to lack supporting documentation will result in refund requests or adjustments to future payments, creating cash flow impact and potential compliance issues.

Original notice

Reminder: We’ll Conduct Postpayment Reviews on Medicaid Claims
bcbsil.com · Always check the source before changing claims.
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