In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated.
Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies.
Notable changes include:
- denial of 3D rendering CPT codes 76376 and 76377
- assistant surgeon and co-surgeon codes eligible for payment
- qualitative drug screen codes eligible for payment; frequency edits on certain codes
- denials on invalid match of diagnosis and procedure code
- changes pertaining to durable medical equipment frequency and rental
- denials of attended sleep studies billed with place of service of 21 (home)
Physicians are encouraged to review the claims editing changes as well as the corresponding detailed payment policies and reimbursement rates to understand how the changes will affect their individual practices.
Physicians can also access the information in the mailer via the Blue Cross website. (Select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section.)
Questions about any of the claims editing rules or payment policies can be directed to Blue Cross Provider Care Department at (800) 677-6669.