ClaimsXtenTM 1st Quarter 2016 Updates and New Rule Notification

Posted December 22, 2015

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 code auditing tool software by the software vendor 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 the software vendor and will confirm the effective date via the News and Updates section of the BCBSIL Provider website. Advance notification of updates to the ClaimsXten software version (i.e., change from ClaimsXten version 4.1 to 4.4) also will be posted on the BCBSIL Provider website.

Beginning on or after March 21, 2016, BCBSIL will enhance the ClaimsXten code auditing tool by adding the first quarter 2016 codes and bundling logic into our claim processing system.

BCBSIL will also implement a new age-specific code replacement rule beginning on or after March 21, 2016. This new rule will help identify claim lines containing procedure codes or preventive evaluation and management codes that may be inconsistent with the member’s age, and for which an alternate code is more appropriate for the member’s age.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim ConnectionTM (C3). C3 is a free, online reference tool that mirrors the logic behind the ClaimsXten code auditing software. For details regarding C3 and ClaimsXten, including answers to frequently asked questions, refer to the Clear Claim Connection page. Additional information also may be included in upcoming issues of the Blue Review.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services.

CPT copyright  2015 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.