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Code Auditing Upgrade and Modifier 59 Exempt Auditing


Blue Cross and Blue Shield of Oklahoma (BCBSOK) hereby gives notice that changes will be made to the claims processing system that affects our bundling logic. We will be upgrading to McKesson ClaimCheck Version 43 effective on or after January 19, 2010 for all lines of business. Due to our licensing agreement with McKesson, mass lists or spreadsheets of bundling combinations cannot be distributed.

Additionally, effective on or about January 19, 2010, BCBSOK will implement changes for modifier 59 exempt code pairs into the claim processing system through ClaimCheck. These changes are based on CMS National Correct Coding Initiative (NCCI).

NCCI guidelines state, "Each NCCI edit has an assigned modifier indicator. A modifier indicator of "0" indicates that NCCI associated modifiers cannot be used to bypass the edit." BCBSOK will continue to use ClaimCheck as the code pair default. NCCI edits (either Incidental or Mutually Exclusive) that are currently not part of the ClaimCheck database will NOT be added.

For further information about current bundling methodologies, or to request specific code to code bundling you may access this information via the online tool, Clear Claim Connection™. Clear Claim Connection™ (CCC), a web-based code auditing reference tool, is available to all contracted BCBSOK providers. To access this new tool, log in to Availity, click "Claims Management" then "Research Procedure Code Edit." Select a payer, and click "Accept." The CCC screen will then appear.



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