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BCBS downcoding E/M services

R

Ree923

Contributor
Messages
15
Location
Bolingbrook, IL
I have just learned that BCBSIL is starting to downcode based on MDM and we will need to submit formal appeals for each claim denied. I also see that IL just signed a law stating that this is not allowed? I am unclear of how to move forward. Our clearinghouse does not allow records to be sent with claims, but the volume of appeals that will be needed makes me concerned. Does anyone know what is happening with the downcoding issues?
 
Hi, I did a bit of searching and Illinois' Transparency in Downcoding Act doesn't go into effect until Jan 1, 2028. (The original version of the bill would have been effective when it was signed into law). This happened recently so BCBSIL might withdraw the policy.

www.isms.org/newsroom-categories/isms-news/may-28-2026-transparency-in-downcoding-act-unanimo
 
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