January 13, 2022

As we recently announced, Blue Cross and Blue Shield of Illinois (BCBSIL) will enhance our claims editing and review process with Cotiviti, INC., for some of our commercial members to help ensure accurate coding of services and that services are properly reimbursed.

What This Means for You: The enhancements require you to continue to follow generally accepted claim payment policies. With your help, the enhanced claims review process will help our members get the right care at the right time and in the right setting.

Note: Inaccurately coded claims will result in denied or delayed payment. 

Attend a Training Webinar
We encourage you attend a free webinar to learn more about the edit enhancements. To sign up, select your preferred date and time from the list below:

What’s changing?
Components of the editing and review enhancements include:

Effective Jan. 10, 2022 – Coding for Services Within the Global Surgical Period
The global surgery package payment policies include all necessary services normally provided by the surgeon before, during and after a surgical procedure, and applies only to primary surgeons and co-surgeons. The global surgery package applies only to surgical procedures that have post-operative periods of 0, 10 and 90 days, as defined by the Centers for Medicare & Medicaid Services (CMS). 

Effective April 1, 2022 – Anatomical Modifiers
CMS-defined anatomical modifiers validate the area or part of the body on which a procedure is performed. Procedure codes that do not specify right or left require an anatomical modifier. This includes procedures on fingers, toes, eyelids and coronary arteries which have specific CMS-defined modifiers.

Effective April 1, 2022 – Diagnosis Code Guidelines
Use of correct ICD-10 codes will be verified. ICD-10-Clinical Modification (CM) diagnosis coding guidelines, including reporting of inappropriate code pairs, as well as correct coding of secondary, manifestation, sequelae, chemotherapy administration, external causes and factors influencing health status diagnoses. These guidelines are contained in the ICD-10-CM Diagnosis Codes Manual.

For more information on the Global Surgical Period edit that took effect on Jan. 10, 2022, see our News and Updates notice from Oct. 12, 2021. For more information on the Anatomical Modifiers and Diagnosis Code Guidelines edits that will take effect on April 1, 2022, see the article in our January Blue Review.

Watch the News and Updates for future announcements.

Cotiviti, INC. is an independent company that provides medical claims administration for BCBSIL. References to other third party sources or organizations are not a representation, warranty or endorsement of such organization.