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October 2021

Coming soon: New edits for Blue Cross commercial claims

At Blue Cross Blue Shield of Michigan, we remain committed to payment integrity solutions that support payment accuracy and encourage correct coding. In support of that commitment, you’ll begin to see new claim edits in the coming weeks and months.

In the July 2021 issue of The Record, we let  you know we would begin enhancing our current claim editing with the addition of new ClaimsXten™ edits. In the August 2021 issue of The Record, we also informed you of edits that will occur through our new partnership with Optum.

ClaimsXten edits will occur in prepayment processing. Optum edits are also prepayment.

Continue to follow the clinical editing appeals process that you currently follow. You’ll be able to recognize these new edits as “clinical editing.” based on the unique provider message codes that will appear on the provider voucher:

  • The new Optum message codes are K500‑K544. 
  • The new ClaimsXten message codes are K211‑K221.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.