BlueCross Announces ClaimsXten Upgrade for 2019

BlueCross Announces ClaimsXten Upgrade for 2019

4/10/18

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina will upgrade their code-auditing system from ClaimCheck® to ClaimsXtenTM, Change Healthcare’s next-generation solution for ensuring proper coding on health insurance claims.

All BlueCross and BlueChoice® lines of business will implement the ClaimsXten platform during the first quarter of 2019. ClaimsXten will allow BlueCross to better align claims adjudication with medical policies, benefit plans, and the Centers for Medicare & Medicaid Services’ (CMS) National Correct Coding Initiative (NCCI). 

CMS developed the NCCI to promote national correct coding methodologies and to control improper coding leading to incorrect payment for medical claims. CMS developed its coding policies based largely on rules defined in the American Medical Association's CPT Manual. Other factors include coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices.

Benefits of ClaimsXten include:

  • Improved payment accuracy and consistency for professional and facility claims

  • Streamlined claims adjudication 

  • Fewer manual reviews

  • Enhanced payment transparency

  • Reduced appeals

  • Clinically supported rules and logic

ClaimsXten simplifies management of complex payment rules and analyzes claims in the context of claims history. While most of the existing ClaimCheck edits will remain in place, ClaimsXten will better analyze codes for issues that include:

  • Deleted CPT codes

  • Unbundled services

  • Fragmented billing of pre- and postoperative care

  • Appropriateness of procedures for age and gender

  • Mismatch of diagnosis and procedure codes

  • Invalid diagnosis codes

  • Investigational or experimental procedures

  • Invalid modifiers 

  • Medically unlikely number of units for the same DOS

If you have questions about this bulletin, you may contact Provider Education at 803-264-4730 or submit your question using the Provider Education Contact Form.