Clarification: New BCBSTX 837 Commercial Claim Validation Edits Effective April 1, 2020
This is a follow-up to provide clarification on a previous notice, posted Feb. 27, 2020.
As of April 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) is implementing enhancements to our electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions). *These enhancements allow claim edits to be applied to claims during the pre-adjudication process, giving you the ability to identify errors earlier in the process and make necessary corrections more quickly.
- Prior to April 1, 2020, electronic claim submissions were accepted into the BCBSTX adjudication system for processing and then denied when needed data elements are not included.
- When you submit claims electronically on or after April 1, 2020, you may see new edit messages on the response files from your practice management system or clearinghouse vendor(s) before the claim is adjudicated. These responses will specify if additional data elements are required.
- If you receive claim rejections, the affected claims must be corrected and resubmitted with the 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.