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Claim Editing Changes for Evaluation and Management Services for Commercial Members, Effective July 1, 2026
Effective date
Jul 1, 2026
Identified
May 3, 2026
Summary
Effective July 1, 2026, Blue Cross Blue Shield of Texas will implement enhanced claims editing for evaluation and management (E&M) services on commercial plans. If billed E&M services don't support the level of service claimed, reimbursement will be automatically adjusted to a lower validated level based on AMA guidelines.
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What to do
Action · 4 steps
01Before July 1, 2026: Billing team and providers must ensure E&M documentation fully supports the level of service billed according to AMA guidelines for medical decision-making.
02Review and strengthen documentation practices for office, inpatient, and outpatient E&M visits.
03Prepare process to submit additional medical records if reimbursement is reduced to a lower service level.
04Claims with insufficient documentation will be automatically reimbursed at lower E&M levels.
Original notice
Claim Editing Changes for Evaluation and Management Services for Commercial Members, Effective July 1, 2026
bcbstx.com · Always check the source before changing claims.