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New Claims Editing Rules To Be Implemented in July 2026
BCBS Texas·TX · Radiation Oncology, Gastroenterology, Emergency Medicine +7 more·Reimbursement
Effective date
Jul 15, 2026
We identified it
May 3, 2026
Summary
Blue Cross Blue Shield of Texas is implementing new claims editing rules in July 2026 that will automatically deny or rebundle claims for various coding scenarios. Claims receiving these edits will show ineligible reason codes with an alpha character 'G' and affect multiple specialties including radiation therapy, STI testing, colonoscopy procedures, and hospital billing.
Action Required
Before July 15, 2026: Billing team must review and update coding practices for affected procedures. Use Clear Claim Connection software to test coding combinations before claim submission. Update billing system rules to prevent denials for: STI testing bundling (use 87801 for multiple tests), colonoscopy injection billing with biopsies, hospital discharge/admit same-day billing, and ensure proper modifiers for anesthesia and bilateral procedures. Train staff on new editing rules to avoid automatic claim denials.