Oct. 28, 2025
Effective March 1, 2026, we’ll enhance our claims editing and review process to ensure accurate billing of claims for members with Blue Cross Community Health PlansSM.
Review these policies and reference guides to become familiar with our requirements:
- Anesthesia – Physical Status Modifiers – Handbook for Practitioners Rendering Medical Service A-221.2 – pages 45 and 46
- Community Based Behavioral Health Services – Community-Based Behavioral Services Provider Handbook 208.3.10 Mobile Crisis Response – pages 37 and 38 / Fee Schedule – page 2
- National Provider Identifier – Provider Sanctions
- Physical Medicine – Therapeutic Services – Healthcare and Family Services Therapy Providers Fee Schedule
- Prostate Cancer Screening – Handbook for Practitioners Rendering Medical Services 225.2 – pages 54 and 55
- COVID-19 – Testing – Illinois Medicaid COVID-19 Fee Schedule
- Invalid Diagnosis Code – Handbook for Providers – General Appendix 5 Error Code Explanations
- Durable Medical Equipment and Supplies Policy – Handbook for Providers for Medical Equipment and Supplies
- Inappropriate Service Modifiers – Modifiers Recognized in Processing Service Claims Illinois Department of Healthcare and Family Services
What this means for you: The enhancements require you to continue to follow generally accepted claim payment policies. Claims that do not follow this guidance may be delayed or denied for payment. With your help, the enhanced claims review process will help our members get the right care at the right time and in the right setting. Please note that this enhancement should not impact response times.
More information: Watch News and Updates for updates.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.