Five Blue Cross Blue Shield State Plans Are Downcoding & Reducing Payments For Evaluation & Management Claims

Five state-level Blue Cross Blue Shield plans operated by Health Care Service Corporation (HCSC) are using claims reviews that can reduce the billed level of evaluation and management (E&M) services and reimburse provider organizations at a lower rate. The change took effect July 1, 2026, and particularly affects specialties such as family medicine, pediatrics, and psychiatry, where E&M services make up a larger share of claims. If a provider organization disagrees with the reimbursed level of service, it can submit medical records to support the originally billed level.

HCSC is an independent licensee of the . . .