ClaimsXten^TM 1st Quarter 2016 Updates and Age-specific Code Replacement Rule Implementation

Blue Cross and Blue Shield of Texas (BCBSTX) reviews new and revised Current Procedural Terminology (CPT^®) and HCPCS codes on a quarterly basis. Codes are periodically added to or deleted from the ClaimsXten code auditing tool software by McKesson and are not considered changes to the software version. BCBSTX will normally load this additional data to the BCBSTX claim processing system within 60 to 90 days after receipt from McKesson and will confirm the effective date on the BCBSTX Provider website. Advance notification of updates to the ClaimsXten software version (i.e., change from ClaimsXten version 4.1 to 4.4) will continue to be posted on the BCBSTX Provider website.

Notification of the following information was published Dec. 15, 2015, in the News and Updates section of our Provider website:

• Effective March 21, 2016, BCBSIL enhanced the ClaimsXten code auditing tool by adding the first quarter 2016 codes and bundling logic into our claim processing system.
• BCBSTX also implemented an age-specific code replacement rule beginning March 21, 2016. This new rule will help identify claim lines containing procedure codes or preventive evaluation and management codes that may be inconsistent with the member’s age, and for which an alternate code is more appropriate for the member’s age.

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 BCBSTX’s code auditing software. For additional information on C3 and ClaimsXten, such as answers to frequently asked questions, refer to the Education & Reference/Provider Tools/Clear Claim Connection page on our Provider website at bcbstx.com/provider. Information also may be published in upcoming issues of the Blue Review.

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.

CPT Copyright 2015 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.