Print

Enhancements to ClaimsXtenTM Code Auditing Tool

April 12, 2013

Blue Cross and Blue Shield of Texas (BCBSTX) will implement an expanded version to the ClaimsXten code auditing tool into our claim processing system beginning on or after July 15, 2013.  Within this implementation will be the new 2nd quarter updates, including but not limited to, revision to A4550 – Surgical Tray. BCBSTX will no longer reimburse for code A4550 Surgical Tray when billed with services performed in the physician's or other professional provider’s office.

The ClaimsXten tool offers flexible, rules-based claims management with the capability of creating customized rules, as well as the ability to read historical claims data. ClaimsXten can automate claim review, code auditing and payment administration, which BCBSTX believes will result in improved performance of overall claims management.

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 BCBSTX’s code-auditing software. Refer to our website at bcbstx.com/provider for additional information on gaining access to C3.

For updates on the ClaimsXten implementation and other BCBSTX news, programs and initiatives, refer to the BCBSTX provider website at bcbstx.com/provider. Additional information also may be included in upcoming issues of the Blue Review.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.

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