Professional Reimbursement Claims Editing Notifications

Anthem Blue Cross and Blue Shield currently utilizes a proprietary, comprehensive, nationally recognized code auditing system to ensure consistent provider reimbursement. This notice is to advise providers that during the timeframe of September 11, 2015 through October 12, 2015, Anthem will phase in claim editing systems such as McKesson Inc.’s ClaimsXten® along with another proprietary auditing system that will automatically apply new or existing edits. These editing systems will allow Anthem to administer claim edits automatically that previously may have required manual intervention or retroactive claim adjustments, achieve consistency with nationally accepted coding guidelines, and facilitate accurate, efficient claims processing. In the Addendum to this document, Anthem has included examples of the new edits that will be effective for September 11, 2015.