Blue Cross Blue Shield of Texas - Upgrade to Bundling Logic

Code Auditing Upgrade
In accordance with Texas law and regulation, Blue Cross and Blue Shield of Texas (BCBSTX) hereby gives notice that changes will be made to the claims processing system that affects our bundling logic. We will be upgrading to McKesson ClaimCheck Version 43 effective on or after September 21, 2009 for all lines of business. Due to our licensing agreement with McKesson, mass lists or spreadsheets of bundling combinations cannot be distributed.

Modifier 59 Exempt Auditing
Additionally, effective on or about September 21, 2009, BCBSTX will implement changes for modifier 59 exempt code pairs into the claim processing system through ClaimCheck. These changes are based on CMS National Correct Coding Initiative (NCCI).

NCCI guidelines state, “Each NCCI edit has an assigned modifier indicator. A modifier indicator of “0” indicates that NCCI associated modifiers cannot be used to bypass the edit.” BCBSTX will continue to use ClaimCheck as the code pair default. NCCI edits (either Incidental or Mutually Exclusive) that are currently not part of the ClaimCheck database will NOT be added.

For further information about current bundling methodologies, or to request specific code to code bundling you may access this information via the online tool, Clear Claim Connection™. Clear Claim Connection™ (CCC), a web-based code auditing reference tool, is available to all contracted Blue Cross and Blue Shield of Texas (BCBSTX) providers. It is available through a secure provider portal at http://www.bcbstx.com/provider/clear_claim_connection.htm

posted 07/2009