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UHC Policy Updates for 2026 

The following coding policies have been revised.  Policy Title: Professional/Technical Component Policy, Professional  Effective Date: April 1, 2026   Summary of Changes: Effective for...

BCBS Downcoding Explanation 

Similar to Cigna claims, several individual BCBS licensees (e.g., Illinois, Texas, Massachusetts) have acknowledged that they will change (recoded/downcode) a claim to a lower‐payment code in certain...

Dec Industry Note: Tennessee Medicare/Medicaid Cross Over Claims 

Effective 9/1/25, The Division of TennCare will no longer process paper crossover claims. Any paper claims received will be returned...

MDwise Update for Indiana 

Starting January 1, 2026, MDwise will no longer participate as a managed care entity for Indiana’s Medicaid.  This includes Healthy...

2026 CPT Code Changes for Urgent Care 

Effective 1/1/2026, the AMA has approved CPT code 87812 to recognize ‘direct optical observation’ results for lab tests testing COVID-19...

Dec Industry Notes: Medicare Open Claim Issues – Part B 

Open claim issues - Part B  The claims issues log below includes the status of claims processing issues that have...

Telehealth Update for Medicare Jurisdiction JH and JL 

Telehealth services are defined as services a physician or practitioner provides via two-way, interactive technology (or telehealth). Telehealth substitutes for...

Update on Processing of Medicare Claims Impacted During the Government Shutdown 

Multiple expiring Medicare statutory payment provisions lapsed on October 1, 2025, due to the absence of Congressional action. With the...

Medicare Part B Claim Issues Impacting JK and J6 Providers 

Denied Laboratory Services and Clinical Laboratory Improvement Amendments (CLIA)   NGS Medicare has been receiving calls from providers regarding denials for...

Nov Industry Notes: Open Claims Issue for Medicare Part B 

The claims issues log below includes the status of claims processing issues that have been identified. We are actively working...

Pennsylvania Department of Human Services Prior Authorization 

PURPOSE:   The purpose of this bulletin is to issue updated handbook pages that include the requirements for prior authorization and...

Nov Industry Notes: Elevance to Penalize Facilities For Out-of-network Providers 

Elevance Health (Anthem) will begin penalizing healthcare facilities in 11 states starting Jan. 1, 2026, for using out-of-network providers for...