New clinical editing resource helps you correct billing errors

We’ve posted a new billing tips resource, titled Clinical Edits: What You Need to Do and What Documentation is Needed, in the Provider Secured Services area of bcbsm.com. It’s expected to provide a clearer understanding of the clinical edits you may encounter and how to resolve them.

To find it, follow these steps:

1. After logging in to Provider Secured Services, click on BCBSM Provider Publications and Resources.
2. Click on Newsletters and Resources and then on Forms.
3. Under Clinical Editing Appeal Form, click on Clinical Edits: What You Need to Do and What Documentation is Needed.

Once you open the document, you can use the keyword search function (Ctrl + F) to search for keywords found on your voucher. Here’s a screenshot of a portion of the new resource:

The document provides a description of our clinical editing policies. We follow nationally recognized rules and guidelines from the Centers for Medicare & Medicaid Services, current procedural terminology codes and guidance from professional practitioner associations and societies. Note: The rules aren’t all‑encompassing and are intended to provide additional guidance and understanding of clinical edits.

The document also outlines your options for correcting billing errors. We offer advice on how to proceed to correct a claim or submit an appeal and specify the required appeal documentation.

In addition to Clinical Edits: What You Need to Do and What Documentation is Needed, you’ll find another useful document on the site: Blue Cross Commercial EX codes: Recommendations Regarding Appeal or Resubmission. It offers a description of EX codes and recommendations on whether you should appeal or resubmit.

Keep in mind that there are many online medical billing and coding resources that can help you understand correct coding guidelines. Accurate claim submission and medical record documentation are crucial to correct reimbursement.

As a reminder, clinical editing is an integral part of our payment policy and you’ll need to use the established guidelines for resolving medical and benefit policy questions.