Code Auditing Update – Texas

February 7, 2012

In accordance with Texas law and regulation, Blue Cross and Blue Shield of Texas (BCBSTX) hereby gives notice that changes will be made to the claims processing system that affects our bundling logic. We will be updating the current McKesson ClaimsXten™ v4.1 to include the 2012 CPT® and HCPCS code changes and the associated bundling logic, effective on or after May 7, 2012 for all lines of business. Due to our licensing agreement with McKesson, mass lists or spreadsheets of bundling combinations cannot be distributed.

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.

BCBSTX quarterly reviews new and revised AMA CPT and HCPCS codes which are added or deleted periodically by McKesson to the ClaimsXten software without changing the software version.  Going forward, BCBSTX will load this additional data to the BCBSTX claim processing system within 60-90 days after receipt of same from McKesson and will confirm the effective date of such load on the BCBSTX website.  Advance notification of updates to the ClaimsXten software version (i.e. change from ClaimsXten v.4.1 to v4.4) will continue to be posted on the BCBSTX website in accordance with Texas law and regulation.

For further information about current bundling methodologies, or to request specific code to code bundling, you may access via the online tool Clear Claim Connection™. Clear Claim Connection™ (CCC), a web-based code auditing reference tool, is available to all contracted Blue Cross and Blue Shield of Texas (BCBSTX) providers.