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ClaimsXtenTM Third Quarter 2013 Updates

July 15, 2013

Blue Cross and Blue Shield of Texas (BCBSTX) 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 software by McKesson without changing the software version. BCBSTX will now load this additional data to the BCBSTX claim processing system within 60 to 90 days after receipt from McKesson and will confirm the effective date on the BCBSTX website. Advance notification of updates to the ClaimsXten software version (i.e., change from ClaimsXten version 4.1 to 4.4) will continue to be posted on our BCBSTX News and Updates page.

Beginning on or after Oct. 14, 2013, BCBSTX will enhance the ClaimsXten code auditing tool by adding the third quarter codes and bundling logic into our claim processing system. 

Additionally, on or after Oct. 14, 2013, based on Centers for Medicare & Medicaid (CMS) guidelines, procedure code A9279 (Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) will bundle to E0470 (Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)) or E0601 (Continuous airway pressure (CPAP) device).  

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 we believe results 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 the Education and Reference/Provider Tools section for additional information on gaining access to C3.

Please continue to watch this website for News and Updates on the ClaimsXten implementation and other BCBSTX programs and initiatives. Additional information also may be included in upcoming issues of the Blue Review.

Checks 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 its products and services.

CPT copyright 2012 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.