This week, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. Most changes will go into effect on December 8, 2012, with a few exceptions that go live on January 1, 2013.
Physicians may notice a difference in how certain codes and code pairs are adjudicated as a result of these changes.
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.
- assistant surgeon and co-surgeon codes eligible for payment
- frequency edits on certain codes
- multiple surgery reductions for certain endoscopic procedures performed on the same day
- application of multiple procedure reduction for the technical component of certain diagnostic imaging procedures performed on same day
- restrictions on payment for prolonged services codes 99354 and 99355
- denial of certain screening services (e.g., Q0091, G0101, G0102) when billed with preventive or problem focused evaluation and management codes
Physicians are encouraged to review the claims editing changes as well as the corresponding detailed payment policies to understand how the changes will affect their individual practices. Information also available on the Blue Cross website. (Select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section after logging in.)
Questions about any of the claims editing rules or payment policies can be directed to Blue Cross Provider Care Department at (800) 677-6669.
If you are a SFMS member experiencing problems with reimbursement and claims issues, please contact our toll-free member reimbursement helpline at (888) 401-5911.