CommercialAdministrativeMedium impact
Enhanced Review of Laboratory, Genetic and Molecular Testing Claims
BCBS Oklahoma·OK · Pathology, Genetics, Oncology·Reimbursement
Effective date
Feb 1, 2027
We identified it
Oct 27, 2026
Summary
Effective February 1, 2027, Blue Cross Blue Shield of Oklahoma will implement enhanced claims review for laboratory, genetic, and molecular testing services. Claims for dates of service on or after that date will be reviewed by Concert (a third-party utilization management company) against AMA and CMS National Correct Coding Initiative guidelines to ensure proper coding. Denied claims will receive notification with next steps.
Action Required
By February 1, 2027: Billing team should ensure all laboratory, genetic, and molecular testing claims are coded according to current AMA and CMS National Correct Coding Initiative guidelines. Verify that claim submission processes align with these standards to minimize denials during the enhanced review process. Train staff on proper coding for these service categories and establish a process to monitor denied claims from Concert for patterns and corrective actions. No workflow changes are stated as required before the effective date, but proactive coding audits are recommended.