ClaimsXtenTM Third Quarter 2014 Updates

Posted June 5, 2014

Blue Cross and Blue Shield of Illinois (BCBSIL) reviews new and revised Current Procedural Terminology (CPT®) and HCPCS codes on a quarterly basis. Codes are periodically added to or deleted from the ClaimsXten software by McKesson and are not considered changes to the software version. BCBSIL will normally load this additional data to the BCBSIL claim processing system within 60 to 90 days after receipt from McKesson and will confirm the effective date on the BCBSIL website.  Advance notification of updates to the ClaimsXten software version (i.e., change from ClaimsXten v.4.1 to v4.4) will continue to be posted on the BCBSIL Provider website.

Beginning on or after Sept. 29, 2014, BCBSIL will enhance the ClaimsXten code auditing tool by adding two new rules into our claim processing system.  

The first new rule is Continuous Positive Airway Pressure or Bi-level Positive Airway Pressure (CPAP/BiPAP) Supply Frequency. This rule identifies supply codes, submitted from all providers for the same member, associated with CPAP/BiPAP therapy that are being submitted at a frequency that exceeds Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) policy for CPAP Supplies. Quantities of supplies greater than those described in a CMS LCD policy will be denied. 

The second new rule is Obstetrics Package Rule. This rule audits claim lines to determine if any global obstetric care codes (defined as containing antepartum, delivery and postpartum services) were submitted with another global OB care code or a component code during the average length of time of the typical pregnancy of 280 days and/or pregnancy plus postpartum period of 322 days.  

Continue to watch the News and Updates for ClaimsXten implementation notifications and other BCBSIL news, programs and initiatives. Additional information also may be included in upcoming issues of the Blue Review 

ClaimsXten is a trademark of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services. 

CPT copyright 2013 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.