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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 Illinois will implement enhanced claims review for laboratory, genetic, and molecular testing services. Claims will be audited against AMA and CMS National Correct Coding Initiative guidelines by Concert, a third-party utilization management company, to ensure proper coding and accurate reimbursement for commercial members.
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What to do
by Feb 1, 2027 · 4 steps
01Billing team must 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 audit claim submissions to align with industry standards.
03Providers should verify that all claim documentation supports the codes submitted.
04Billing staff should prepare to receive denial letters with next steps for any claims identified as improperly coded during the enhanced review process; establish a procedure to review and respond to these notices.
Original notice
Enhanced Review of Laboratory, Genetic and Molecular Testing Claims
bcbsil.com · Always check the source before changing claims.