Blue Review - Blue Cross and Blue Shield of Oklahoma

Jan. 8, 2015

ClaimsXten^TM to Add Correct Coding Initiative Rule

Beginning on or after March 23, 2015, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will enhance the ClaimsXten code auditing tool by adding the Centers for Medicare & Medicaid Services (CMS) Correct Coding Initiative Rule into our claim processing system. The purpose of this new rule is to identify claims containing code pairs found to be unbundled according to the CMS National Correct Coding Initiative (NCCI). The CMS NCCI coding policies are based on coding conventions defined in the American Medical Association’s (AMA) Current Procedural Terminology (CPT^®) manual; national and local Medicare policies and edits; coding guidelines developed by national societies; standard medical and surgical practice and/or current coding practice.

The ClaimsXten tool offers flexible, rules-based claims management with the capability of creating customized rules, as well as the ability to read historical claims data. ClaimsXten can automate claim review, code auditing and payment administration, which we believe results in improved performance of overall claims management.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim Connection^TM (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSOK code-auditing software.

Refer to Clear Claim Connection page section our website at bcbsok.com/provider for additional information on gaining access to C3.

For updates on ClaimsXten, watch the News and Updates section on our provider website, as well as upcoming issues of the Blue Review.

Checks of eligibility and/or benefit information are not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services.

Blue Cross and Blue Shield of Oklahoma is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.