New Code Auditing Tool to Help Improve Claim Processing is Now Effective

May 4, 2011

On December 14, 2010, Blue Cross and Blue Shield of Texas (BCBSTX) provided notice of the implementation of new code auditing software within the BCBSTX claim processing system to be effective on or after April 18, 2011. The new software, ClaimsXtenTM, is a code auditing tool developed by McKesson Information Solutions, Inc.

This is to notify you that the ClaimsXten software became effective for claims with dates of service on or after May 2, 2011. During implementation we identified scenarios that could result in overpayment on certain professional claims that had procedure codes 99201-99205 submitted with any other CPT/HCPCS code. BCBSTX will correct this issue on May 6, 2011 and will not request refunds for any overpayments resulting from the code combinations noted above.

In addition to mirroring the logic that is currently featured in the ClaimCheck®'' system, ClaimsXten will allow BCBSTX to expand claim processing with aggregate historical claims data. This will assist in adjudicating claims more effectively and in a more cost-effective manner. With the implementation of ClaimsXten, BCBSTX will be better able to evaluate claims for global periods, as designated by the Centers for Medicare and Medicaid Services (CMS) physician fee schedule, in addition to reviewing multiple claims for a single date of service.

Clear Claim ConnectionTM (C3) will continue to be the provider resource that allows disclosure of claim auditing rules and clinical rationale to the BCBSTX contracting provider network. C3 is a free online tool available to providers who are registered with Availity®' or RealMed®'''. Once you are registered, you may connect directly to C3 via your preferred vendor portal.

  • Availity users – After logging on to the Availity provider portal , look for "Claims Management/Research Procedure Code Edit." If you are not currently a registered user, visit Availity  to sign up, or contact Availity client services at 800-AVAILITY (282-4548).
  • RealMed users – Log on to RealMed  or call 877-REALMED (732-5633) for assistance.

Learn more about Clear Claim Connection.

ClaimsXten, ClaimCheck and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc.
Availity is a registered trademark of Availity, L.L.C.
RealMed is a registered trademark of RealMed Corporation.
McKesson Information Solutions, Inc., Availity, L.L.C and RealMed Corporation are independent third party vendors and are solely responsible for their products and services. BCBSTX makes no representations or warranties regarding the products or services provided by any of these vendors. If you have any questions regarding the products or services provided by these vendors, you should contact the vendor directly.