ClaimsXten™ will include additional professional and outpatient facility editing in July

ClaimsXten will edit additional services for professional and outpatient providers starting in July 2018. These new edits will promote correct coding and simplify our claims payment systems.

Here are highlights:

• New patient services billed for established patients by professional providers within the established time frames will deny for correct established patient code.
• Anesthesia services reported with non-anesthesia codes that aren’t eligible to be reported for anesthesia providers will deny for resubmission with the correct anesthesia code.
• Procedures that allow global component billing that are reported by more than one provider for the same component will deny. Blue Cross’ payment policy only pays up to the global component fee.
• Claim lines containing services that are unbundled, according to the Centers for Medicare & Medicaid Services National Correct Coding Initiative, aren’t recommended for reimbursement and will deny.

When appropriate, Blue Cross will support the use of modifiers that indicate unique circumstances for individual patients. The use of modifiers should be documented in the patient’s medical records.