Vermont Blue Advantage (VBA) Claims Reminder

REQUIREMENTS: - By December 31, 2026: Billing team must submit all claims for VBA members with dates of service in 2025. Claims can be faxed to (800) 479-8973. Failure to submit by this deadline will result in claim denials. - Immediately: Billing team must enroll in Electronic Fund Transfer (EFT) before October 1, 2026, as paper check payments will no longer be issued. Contact VBA Provider Services at (844) 839-5122 to enroll. - Before October 30, 2026: Billing team must audit all NDC billing submissions to ensure compliance with NDC, Unit of Measure, and Quantity requirements. Update billing software as needed. Claims processed on or after October 30, 2026, will be systematically denied for non-compliance. - For dates of service on or after September 1, 2026: Billing team and providers must update obstetric claim submission to use E/M codes with modifier -TH and ICD-10-CM Z34A codes for first prenatal visits. Subsequent antepartum visits require E/M codes with modifier -TH. Documentation must support medical decision making per CPT guidelines. Prior to September 1, 2026, continue using global obstetric codes (59425, 59426). - By September 16, 2026: Encourage billing professionals, coders, and providers to attend the webinar on new obstetric billing codes to ensure readiness for 2027 transition. - Ongoing: Ensure timely filing compliance—all claims must be submitted within 180 days of service date or face denial. Verify claim status in Provider Resource Center after 30 days of submission.