Member Rights and Responsibilities

MATERNITY BILLING: By September 1, 2026, billing team must update billing software and templates to implement new prenatal care coding requirements. For dates of service on/after September 1, 2026: (1) First prenatal visits must be billed with an E/M code + modifier -TH AND appropriate Z34A ICD-10 code (4th character required for gestation); (2) Subsequent antepartum visits require E/M code + modifier -TH with documentation supporting MDM or time per CPT guidelines; (3) Pre-September 1, 2026 claims continue using current codes 59425 (4-6 visits) or 59426 (7+ visits). Update encounter forms and provider education materials immediately. PAYMENT METHOD: By October 1, 2026, all providers must enroll in Electronic Fund Transfer (EFT) at providerrelations@bcbsvt.com or (888) 449-0443 option 1. After October 1, 2026, paper checks will no longer be issued—failure to enroll in EFT will result in payment delays. PROVIDER DIRECTORY VALIDATION: Billing/credentialing team must complete quarterly directory validation within 30 days of notification or claims will be denied until validation is complete; denied claims must be resubmitted. ADMINISTRATIVE: Contact providerrelations@bcbsvt.com for updated MD Rx and Community Home Infusion Therapy fee schedule effective October 1, 2026.