PerformCare Rejects IBHS Claims With a Primary ID Diagnosis, Back to July 1

PerformCare, a Pennsylvania behavioral health MCO, told its IBHS network on August 17 that IBHS claims “submitted with a primary diagnosis that qualifies as ID are expected to reject” for dates of service on or after July 1, 2026. The codes are F70, F71, F72, F73, F78 and F79. The notice ties the edit to OMHSAS's July 2026 update of the Behavioral Health Services Reporting Classification Chart (BHSRCC), which drives PROMISe encounter validation.

The turn: the edit went live six weeks before the notice

The edit reaches back to July 1, and the notice is dated August 17. Any IBHS claim from July or August with ID sequenced first may already have denied. PerformCare says those providers “may receive claim denials” and “should resubmit corrected claims, as applicable.”

The notice also rules out the obvious fix. “Providers must not change diagnosis sequencing solely to obtain payment.” An ID diagnosis can still appear as secondary. The primary diagnosis has to be “the behavioral health condition that is the basis for the IBHS service,” and it has to match the record.

What else it says

• Authorizations: if the documentation lists only ID, or ID as primary, PerformCare “may request clarification or updated documentation before completing review.”
• Audience: the notice goes to IBHS prescribers, the clinicians who write the order, and copies the Capital Area and Tuscarora contracts.
• Process: written orders, assessments and treatment plans otherwise go through the existing process.

The limits

The BHSRCC isn't public, so we couldn't read the underlying edit. It sits in state encounter validation, but only PerformCare has published a notice. We checked the notice lists for Community Care, Magellan and CBH, and none mentions it. The notice gives no correction deadline beyond normal claim rules.

What you must know or do

• Billers (PerformCare): run every IBHS claim with dates of service from July 1 and a primary F70–F79. For each, compare the primary diagnosis with the written order and assessment.
• Where the record supports autism or another behavioral health condition as the basis, correct the sequencing to match and resubmit.
• Where it doesn't, take it to the prescriber, not the billing system. The notice forbids resequencing for payment.
• Billers (other BH-MCOs): run the same query against your July–September remittances. An unexplained rejection there is your signal.
• Intake: check that new written orders name the behavioral health condition first.