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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 Texas will implement enhanced claims review for laboratory, genetic, and molecular testing services. All such claims will be reviewed by Concert (a contracted healthcare technology company) against American Medical Association and Centers for Medicare & Medicaid Services National Correct Coding Initiative guidelines to ensure proper coding alignment. Denied claims will receive notification with next steps.
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What to do
by Feb 1, 2027 · 4 steps
01Billing team must ensure that all laboratory, genetic, and molecular testing claims submitted for dates of service on or after this date comply with American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative guidelines.
02Providers should verify that claim coding for these services uses the most appropriate code(s) based on medical record documentation and coding guidelines.
03Billing staff should monitor for denial letters from Concert and follow the specified next steps for any denied claims.
04No changes to billing software or workflows are mandated by this notice, but claims that do not align with AMA/CMS coding standards will be subject to denial.
Original notice
Enhanced Review of Laboratory, Genetic and Molecular Testing Claims
bcbstx.com · Always check the source before changing claims.