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New Code Auditing Tool to Help Improve Claim Processing

November 17, 2009

In the October Network News and News and Updates section of the Provider website, we announced the implementation of new code auditing software within the BCBSOK claim processing system. On or after April 18, 2011, BCBSOK will implement ClaimsXtenTM, a code auditing tool developed by McKesson Information Solutions, Inc.

In addition to mirroring the logic that is currently featured in the ClaimCheck® system, ClaimsXten will allow BCBSOK to expand claim processing with aggregate historical claims data. This will assist in adjudicating claims in a manner that is more efficient and cost-effective. With the implementation of ClaimsXten, BCBSOK will be better able to evaluate claims for global periods, as designated by the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule, in addition to reviewing multiple claims for a single date of service.

Clear Claim ConnectionTM (C3) will continue to be the provider resource that allows disclosure of claim auditing rules and clinical rationale to the BCBSOK contracting provider network. C3 is a free online tool available to providers who are registered with Availity®. After logging on to the Availity provider portal, look for Claims Management/Research Procedure Code Edit. If you are not currently a registered user, visit Availity to sign up.

For more information about Clear Claim Connection, along with ClaimsXten Frequently Asked Questions (FAQs) , visit the Education and Reference Center / Provider Tools section of our website at bcbsok.com/provider.

ClaimsXten, ClaimCheck and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc.

Availity is a registered trademark of Availity, L.L.C.

McKesson Information Solutions, Inc. and Availity, L.L.C are independent third party vendors and are solely responsible for their products and services. BCBSOK makes no representations or warranties regarding the products or services provided by either of these vendors. If you have any questions regarding the products or services provided by these vendors, you should contact the vendor directly.