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Review of Implant Claims from Stand-Alone ASCs

September 28, 2019

Blue Cross and Blue Shield of Texas (BCBSTX) is changing the way we review claims for implants performed at free-standing ambulatory surgery centers (ASCs). On behalf of BCBSTX, EquiClaim currently reviews implant claims submitted by hospitals and hospital outpatient departments for services provided to our members. As of Dec. 15, 2019, EquiClaim will also provide post-payment review for all ASC claims with implant charges.

Claims containing implant charges in any combination of revenue and procedure codes will be reviewed for:

EquiClaim will let you know if your claim for an implant was incorrectly paid. They will tell you how to repay the funds or appeal the decision.

As stated in the BCBSTX recoupment guidelines, we may recoup payment for any implant that does not meet our requirements. Providers can refer to the Clinical Payment and Coding Policies and the provider manuals under Standards and Requirements on the provider website.

If you have any questions or concerns, contact Provider Customer Service at 1-800-451-0287.

EquiClaim, a Change Healthcare Solution, an independent company, provides payment integrity solutions for Blue Cross and Blue Shield of Texas.