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New Claims Editing Rules To Be Implemented in July 2026
BCBS Montana·MT · Radiation Oncology, Gastroenterology, Oncology +5 more·Reimbursement
Effective date
Jul 15, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of Montana is implementing 18 new automated claims editing rules in their Lyric software database effective July 15, 2026. These rules will automatically deny or rebundle claims that don't meet specific coding requirements, with denials showing reason codes beginning with 'G'.
Action Required
By July 15, 2026: Billing team must review and update billing practices for all affected codes to prevent automatic claim denials. Key actions: 1) Ensure CPT 77301 is billed within 30 days of radiation therapy codes, 2) Bundle STI testing codes (87491, 87591, 87661) into comprehensive code 87801 when appropriate, 3) Limit J9299 (Nivolumab) to maximum 480 units per 4 weeks, 4) Stop billing injection code 45381 with colonoscopy biopsy/polypectomy procedures, 5) Add modifier 54 for ER surgical procedures without follow-up care, 6) Verify appropriate modifiers for anesthesia and bilateral procedures, 7) Ensure primary diagnoses are not administrative or social determinant codes. Update billing software rules and staff training. Claims not meeting these criteria will be automatically denied.