February 27, 2020
As of April 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will implement new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions). *
What does this mean?
- These claim edits will be applied to claims during the pre-adjudication process.
- This will help increase administrative efficiencies and provide you quicker notification of what is needed for the claim to process.
- Compliance with Centers for Medicare and Medicaid (CMS) data reporting requirements.
What should you do?
- Review claim edit messages on the response files from your practice management/hospital information system or clearinghouse vendor(s).
- Determine if additional data elements are necessary.
- Correct and resubmit affected claim(s) with needed information as specified in the rejection message.
- If you have questions regarding an electronic claim rejection message, contact your practice management/hospital information system software vendor, billing service or clearinghouse for assistance.
*These new validation edits apply to Blue Advantage HMOSM, Blue Choice PPOSM, Blue EssentialsSM, Blue PremierSM and MyBlue HealthSM. They do not apply to BCBSTX Medicare Advantage and Texas Medicaid electronic claims.