Arkansas Blue Cross's September 2026 payment notice, its original 2024 announcement, and CMS guidance
Home-health agencies billing Arkansas Blue Cross and Blue Shield have a November 1 payment date to check. The insurer will apply its 85% assistant-service reimbursement methodology consistently across its lines of business, including institutional home-health claims.
In brief
- The notice expressly includes home-health services billed on UB-04 forms or 837I transactions.
- Payment is based on the calculated PT/OT allowable amount.
- The underlying assistant-services policy dates to 2024.
A claim-form distinction with a payment consequence
The September newsletter says policy AR_PC_000016 always intended to cover outpatient professional services furnished by physical therapist assistants and certified occupational therapy assistants. The insurer found variation in how it applied the policy to home-health claims. Its revised wording explicitly includes those services on institutional forms; covered services must still meet the policy's conditions.
For an agency whose affected claims have been paid at the full therapist allowable, the stated percentage warrants a revenue check. An illustrative $100 calculated allowable would yield $85 under that methodology. The actual effect depends on the agency's contracts and prior claims payment.
The assistant differential has a history
Arkansas Blue Cross's September 2024 announcement established November 1, 2024, as the start of its assistant-services reimbursement policy. That announcement already specified the 85% rate and CQ or CO modifiers, with services reported by the supervising therapist. The 2026 notice describes a clarification of existing intent, giving agencies a reason to inspect how their own claims were handled before estimating a new loss.
Medicare Part B has a separate statutory assistant-payment differential, effective since January 2022. CMS explains when CQ and CO modifiers apply and provides examples for visits shared by therapists and assistants. Agencies should use each payer's applicable policy when configuring claims.
Check the first November remittance
A practical review can start with a small sample of recent OTA claims. Record the product, claim format, modifier, calculated allowable, and amount paid, then ask the payer how the November implementation applies to that combination. Claims already paid under the assistant methodology need a different financial forecast from claims that have been paid at the full therapist rate.
Keep the payer's answer with the billing instructions and compare it with the first affected remittance. A mismatch is easier to investigate when the office can identify the service, claim format, and expected calculation. That preparation gives the treating team a clearer account of payment while keeping care decisions tied to the patient's needs.