October Medicare and Medi-Cal claims updates and Noridian service downtime
Oct 4, 2026 edition · GC-2026-0012 · Published 2026-10-04 · Version 2 · Final
October claims preparation spans replacement OPPS/I-OCE instructions, DMEPOS and coding updates, with distinct service, claim-received and systems dates plus planned CWF downtime.
What happened
CMS's September 29, 2026 replacement instructions include R13978CP for OPPS and R13979CP for I/OCE version 27.3. The separate R13956CP instructions address the DMEPOS quarterly fee-schedule update. They identify October 1 effectiveness and October 5 systems implementation, subject to item-specific dates. The OPPS replacement adds revised policy language, requirements, education and tables; the I/OCE replacement finalizes attachments and adds two business requirements. September 28 R13977OTN also replaces earlier October EDI front-end instructions to update the 276/277 flat-file attachment. Updating a code file does not by itself establish coverage for every item or service.
Other October work includes laboratory fee-schedule/CLIA edits effective October 1, the home-health grouper version 07.2.26 and physician-fee-schedule code and indicator updates. DHCS's September 29 HCPCS notice applies listed benefit-code changes generally to October 1 dates of service, unless specified otherwise; its NCCI notice instead uses claims received on or after October 1. CMS MM14561 identifies October 5 implementation for SNF consolidated-billing changes, with individual table dates that must also be checked. Noridian's September 1 notice schedules CWF dark days October 2–4, limiting specified portal, IVR and customer-service functions, not every service. As of October 4 the scheduled window included that day; the notice alone does not prove restoration.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal, California
- Affected functions
- Revenue Cycle, IT, Coding, Finance
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-10-05
- Date type
- implementation
Why it matters
A single October release date misses distinctions among dates of service, claim receipt and systems implementation. Vendor confirmation needs to identify the actual file/version loaded.
Recommended action
Reconcile current CMS and DHCS files with the claims and home-health system owners, test relevant codes and retain release confirmation. Use DHCS claim-received timing for NCCI and listed service dates for HCPCS. Confirm live availability after planned downtime and resolve any MAC/CMS date discrepancy before relying on a summary.
Sources
- Transmittal R13934OTN, change request 14429, HIPAA electronic data interchange front end updates for October 2026Official · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-08-31
- Transmittal R13929CP, change request 14588, quarterly update to the Medicare Physician Fee Schedule Database, October 2026Official · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-08-31
- MLN Connects newsletter, August 27, 2026Official · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-08-31
- MLN Connects, September 3, 2026Official · CMS · 2026-09-03 · Source review 2026-09-06
- MM14561, SNF consolidated billing October updateOfficial · CMS · 2026-09-02 · Source review 2026-09-06
- NCCI quarterly update effective October 1Official · DHCS · 2026-08-31 · Source review 2026-09-06
- Portal, IVR and customer-service limited availability October 2-4Official · Noridian, Jurisdiction E · 2026-09-01 · Source review 2026-09-06
- CMS Transmittal R13978CPOfficial · Centers for Medicare & Medicaid Services · 2026-09-29 · Source review 2026-10-04
- CMS Transmittal R13979CPOfficial · Centers for Medicare & Medicaid Services · 2026-09-29 · Source review 2026-10-04
- CMS Transmittal R13956CPOfficial · Centers for Medicare & Medicaid Services · 2026-09-29 · Source review 2026-10-04
- 2026 HCPCS Quarter 4 UpdateOfficial · DHCS · 2026-09-29 · Source review 2026-10-05
- Official retained source documentOfficial · Official issuing agency · Source review 2026-10-16
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
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