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Enhanced Review of Laboratory, Genetic and Molecular Testing Claims
Act
by Feb 1, 2027
Effective date
Feb 1, 2027
Identified
Oct 27, 2026
Summary
Effective February 1, 2027, Blue Cross and Blue Shield of New Mexico will implement enhanced claims review for laboratory, genetic, and molecular testing services using AMA and CMS National Correct Coding Initiative guidelines. Claims for dates of service on or after February 1, 2027, will be reviewed by Concert (a contracted healthcare technology company) for proper coding compliance; denied claims will receive notification with next steps.
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What to do
by Feb 1, 2027 · 3 steps
01Billing team and providers should ensure all laboratory, genetic, and molecular testing claims comply with current AMA and CMS National Correct Coding Initiative guidelines.
02Review internal coding practices for these service categories and verify that claims submitted on or after February 1, 2027, use appropriate codes based on medical record documentation and applicable coding standards.
03No specific code changes were identified in this policy; however, claims that do not align with AMA/CMS guidelines may be denied by Concert's review process, requiring corrective resubmission.
Original notice
Enhanced Review of Laboratory, Genetic and Molecular Testing Claims
bcbsnm.com · Always check the source before changing claims.