ClaimsXten™ First Quarter 2014 Updates
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 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 the BCBSTX website.
Beginning on or after February 10, 2014, BCBSTX will enhance the ClaimsXten code auditing tool by adding the fourth quarter 2013 and first quarter 2014 codes and bundling logic into our claim processing system.
Additionally, on or after Feb. 10, 2014, the following additional edits will be added, based on CPT and HCPCS code descriptions: procedure code S2900 (Surgical techniques requiring use of robotic surgical system) will bundle to 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed). And procedure code S9088 (Services provided in an urgent care center) will be considered inclusive to all Evaluation and Management services.
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.
BCBSTX will continue with the modifier 59 exempt program through ClaimsXten. This program is 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 ClaimsXten as the code pair default. NCCI edits (either Incidental or Mutually Exclusive) that are currently not part of the ClaimsXten database will NOT be added.
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 Connection™ (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSTX's code-auditing software. Refer to our website at bcbstx/provider for additional information on gaining access to C3.
For updates on ClaimsXten, watch the News and Updates on our Provider website, as well as upcoming issues of the Blue Review.
Checking eligibility and/or benefits 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.