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New Code Auditing Tool to Help Improve Claim Processing

Nov. 12, 2010

In the October Blue Review , we announced the implementation of new code auditing software within the BCBSIL claim processing system. On or after March 21, 2011, BCBSIL will implement ClaimsXtenTM, a code auditing tool developed by McKesson Information Solutions, Inc. 

In addition to mirroring the logic that is currently featured in the ClaimCheck® system, ClaimsXten will allow BCBSIL to expand claim processing with aggregate historical claims data. This will assist in adjudicating claims in a manner that is more efficient and cost-effective. With the implementation of ClaimsXten, BCBSIL will be better able to evaluate claims for global periods, as designated by the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule, in addition to reviewing multiple claims for a single date of service. 

Clear Claim ConnectionTM (C3) will continue to be the provider resource that allows disclosure of claim auditing rules and clinical rationale to the BCBSIL independently contracted provider network. C3 is a free online tool available to providers who are registered with Availity® or RealMed®. Once you are registered, you may connect directly to C3 via your preferred vendor portal.

  • Availity Users – After logging on to the Availity provider portal This link will take you to a new site not affiliated with BCBSIL. It will open in a new window. To return to our website, simply close the new window. Refer to Important Information for our linking policy.,  look for Claims Management/Research Procedure Code Edit. If you are not currently a registered user, visit Availity This link will take you to a new site not affiliated with BCBSIL. It will open in a new window. To return to our website, simply close the new window. Refer to Important Information for our linking policy. at http://www.availity.com/ This link will take you to a new site not affiliated with BCBSIL. It will open in a new window. To return to our website, simply close the new window. Refer to Important Information for our linking policy. to sign up, or contact Availity Client Services at (800) AVAILITY (282-4548).
  • RealMed Users – Log on to RealMed This link will take you to a new site not affiliated with BCBSIL. It will open in a new window. To return to our website, simply close the new window. Refer to Important Information for our linking policy. or call (877) REALMED (732-5633) for assistance.

For More Information

Visit the Education and Reference Center / Provider Tools section of our website for more information about Clear Claim Connection, including answers to ClaimsXten Frequently Asked Questions (FAQs) .

ClaimsXten, ClaimCheck and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc.

Availity is a registered trademark of Availity, L.L.C. 

RealMed is a registered trademark of RealMed Corporation. 

McKesson Information Solutions, Inc., Availity, L.L.C and RealMed Corporation are independent third party vendors and are solely responsible for their products and services. BCBSIL makes no representations or warranties regarding the products or services provided by any of these vendors. If you have any questions regarding the products or services provided by these vendors, you should contact the vendor directly.