June 1, 2026
Effective Sept. 1, 2026, we’ll enhance our editing process for sepsis care for some commercial members to help ensure accurate coding and proper reimbursement of services.
What’s changing: Effective Sept. 1, 2026, Machinify will provide prepay review on some diagnosis-related group claims for sepsis for proper coding and medical necessity.
For more general guidance, review our Reimbursement Policy CPCP041 – Sepsis Policy.
What this means for you: The enhancements require you to continue to follow generally accepted ICD-10-CM coding guidelines. With your help, the enhanced claims review process will help ensure coding and claims processing accuracy. This change should not increase response times.
Watch News and Updates for future updates.
Machinify is an independent company that has contracted with Blue Cross and Blue Shield of Texas to provide utilization management services for members with coverage through BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services they offer.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.